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BED WETTING IN CHILDREN

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Bed Wetting Treatment in Bangalore for Children | Nelivigi Multispeciality

Bedwetting is medically called enuresis. It most commonly occurs during sleep in the night time. The medical term then for it is nocturnal enuresis (quite a mouthful, like most medical terminologies are!). This occurs in both boys and girls but is more common in boys. Bedwetting occurs in about 7-8% of children by the age of 7 years. Even at the age of 10 years 4% of the children may have it and this surprisingly continues in adulthood with an incidence of less than 2%. This suggests that with increasing age, the incidence of bedwetting decreases by about 15%   every year on its own.

Types of eneuresis:

 There are two types of enuresis. The most common variety is called primary nocturnal enuresis in which the child always has had bedwetting ever since birth. The less common type is the secondary type where the child attains control of night time urination but after about 6 months starts bedwetting.

Causes of nocturnal enuresis:

The normal urine control is a function of age. Children attain bladder and bowel control in the following sequence.

  • Bowel control at night
  • Bowel control during the day
  • Bladder control during the day
  • Bladder control at night

This control is achieved earlier in girls than in boys.

The most common cause for primary bedwetting is delayed neurological development of urinary control. Such delays happen with all our milestones like speech, walking, learning etc.

It also has been seen that most of these children are deep sleepers. In a normal child, bladder filling elicits a wake response and the child goes to the toilet in the night if he senses full bladder. In a child with deep sleep, a sensory response like bladder filling is not registered. Therefore the child leaks urine.

There are other causes too like reduced secretion of AVP which is a hormone responsible for reduction in the quantity of urine production.

Another purported theory is the slow increase in the functional bladder capacity which means the child cannot hold enough urine in the bladder.

Evaluation:

 The urologist takes a thorough history to differentiate between various types of bedwetting. A physical examination will rule out any neurological problems .Once it is established that the child is suffering from nocturnal enuresis, a few tests will help in ruling out other rare possibilities. These tests may include urine test to rule out infection and ultrasound scan abdomen to rule out bladder and kidney abnormalities.

Treatment:

 There are various strategies to treat this problem. They are:

1) Restriction of fluids in the night time

2) Emptying the bladder just before sleep

3) Waking up the child once in the midnight or after that to empty the bladder

4) Bladder training: The child is asked to hold urine for progressively longer period of time so that the holding capacity of bladder increases.

5) Reward: The parents encourage the child every time he is dry.

6) Using alarms which go off the moment the child wets the bed. This alarm wakes up the child so that he can complete the rest of the urination in the toilet

7) Pharmacotherapy or drug therapy: These drugs are of two types. Either they decrease the urine output or reduce bladder contractility. They are safe and effective even on long term use.

Outcomes:

Almost all children grow out of bedwetting as they become older. Parents need patience and understanding because it is not a disease but a delay in developmental milestone.