Bed wetting or nocturnal enuresis is a very common problem faced by the parents. But I think more than parents, it is a psychological trauma to the child him/herself! This fact is forgotten most of the times. In this article I have tried to make the parents aware about this problem and how to approach it in a positive way. Because in most cases parents discuss this issue in front of others or scold and sometimes physically abuse the children on this. The first and foremost thing to understand is that this is not their mistake that they wet the bed at night. We need to find out the reason for that and help them to get out it in a positive way.
Types of bed wetting
Primary type:
In this type, the children never attain bladder control and continues to wet the bed like newborn babies even after 5 years of age. Normally bladder control starts at 2 years and almost all children become dry by day and night by the age of 5 years. In this group, this does not happen. Most common cause for this is the immaturity of the neural control on bladder and this needs further evaluation. This has a genetic predisposition also. Sometimes concealed lesions in the spinal cord can also can cause such primary type of incontinence.
Secondary type:
They are normal children who attained bladder control normally and then loose secondarily. Mostly it will have a secondary cause leading to this for Eg- UTI, Constipation etc.
Causes of bed wetting
Primary type:
- Usually due to immature neural control over the bladder.
- Spinal cord lesions
- Genetic
- Brain lesions
Secondary type:
- Urinary tract infections
- Constipation
- Micturition deferral
- Mental stress
- Anxiety
Approach to bed wetting
The first step in the approach is to take a detailed history and type it as either primary or secondary. We need to take relevant history to find the exact reason behind it. It may need a psychologist’s help too.
Investigations needed:
It should be designed according to the type of enuresis. Anyway we will have to rule out a urinary tract infection by a n urine culture test. We will have to do relevant imaging studies too. This will vary from case to case. A detailed examination of the child is very important too.
Treatment:
- It also depends on the type. But you can follow some general rules like
- Never scold or humiliate them in front of others. It will only worsen the situation. Be kind and supportive to them.
- Keep a calendar on dry and wet days and give the child star for the dry days. It will encourage them to keep themselves dry at night. You can give small rewards also for the same.
- Avoid fluids at least 2hours prior to bed
- Take them to toilet and make them void immediately before going to bed
- Keep alarm at regular intervals and take them to toilet for voiding.
- Treat UTI if detected
- Treat constipation if present.
- Train good toilet habits
- Address micturition deferral if present
- Provide good toilet facility at schools.
- Encourage them to pass urine whenever needed without holding it for a long time.
- Some may need surgical corrections if any spoinal cord lesions are detected.