Bedwetting, also known as nocturnal enuresis or nighttime incontinence, refers to unintentional urination during sleep.
Enuresis is the medical term for wetting, whether in clothing during the day or in bed at night. For infants and young children, urination is involuntary. Wetting is normal for them. Usually, most kids are dry by day 2-3 yrs and dry by night by 3-5 yrs. Daytime control is usually achieved first, while nighttime control comes later.
Bedwetting is a normal part of your child’s development, hence, do not despair. Soggy sheets and pajamas and an embarrassed kid are familiar scenes in many homes.
The age at which bladder control is expected varies considerably. Some parents expect dryness at a very early age, while others not until much later. Such a timeline may reflect the culture and attitudes of the parents and caregivers.
Usually, bedwetting before the age of 7 is not a concern but if the problem persists, then treatment approaches such as lifestyle changes, bladder training, and sometimes medications may help.
When To Consult a Doctor?
Most of the children outgrow bedwetting on their own, but a few might need help. In some cases, bedwetting can be a sign of an underlying condition that needs medical attention. The signs are:
Your child wets the bed even after age 7.
If your child starts bedwetting after few months of being dry at night.
If your child experiences pain, unusual thirst, red or pink-colored urine, hard stools, or snoring.
Causes of Bedwetting
No one knows the exact causes of bed-wetting but various factors may play a role:
1. A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
2. Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child, especially if your child is a deep sleeper.
3. A hormone imbalance. During childhood, some kids don't produce enough antidiuretic hormone (ADH) to slow nighttime urine production.
The antidiuretic hormone helps to control blood pressure by acting on the kidneys and the blood vessels. Its most important role is to conserve the fluid volume of your body by reducing the amount of water passed out in the urine.
4. Stress. Stressful events, such as becoming an elder brother or sister, starting a new school, or sleeping away from home, may trigger bedwetting.
5. Urinary tract infection. Urinary tract infections (UTIs) are common in kids. They happen when bacteria (germs) get into the bladder and to the kidneys through the urethra.
A baby with a UTI may have a fever, throw up, or be fussy. Older kids may have a fever, have pain when peeing, need to pee a lot, or have lower belly pain.
This infection can make it difficult for your child to control urination and symptoms such as daytime accidents, frequent urination, pain while urination is observed.
6. Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep.
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If your kid snores loudly and feels tired even after a full night's sleep, he/she might have sleep apnea.
The main type is obstructive sleep apnea (OSA), which occurs due to the narrowing/blocking of upper airways during sleep.
7. Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Diabetes in kids is known as juvenile diabetes where the pancreas (an organ located in the abdomen that plays an essential role in converting the food you eat into fuel for the body's cells) produces little or no insulin (a hormone that regulates the metabolism of carbohydrates, fats, and protein by promoting the absorption of glucose from the blood).
8. A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect, disease, or an injury in the child's neurological system or urinary system.
This disrupts the neurological balance that controls urination. A neurological system (nervous system) is a complex system that coordinates actions and senses by transmitting signals to and from different parts of your body.
9. Constipation. In children, the muscles which are responsible for controlling urine are the same as those for controlling bowel movements. Hence, when constipation persists for long, the muscles can become dysfunctional and contribute to bedwetting at night.
Symptoms of Bedwetting
Wetting during the day.
Frequency, urgency, or burning on urination.
Straining, dribbling, or other unusual symptoms with urination.
Cloudy or pinkish urine, or blood stains on underpants or pajamas.
Soiling, being unable to control bowel movements.
Factors Responsible For Bedwetting
Bedwetting is twice as common in boys as in girls. Some factors associated with bedwetting include:
Stress and anxiety
Family history
ADHD (Attention-deficit hyperactivity disorder). This is a mental health disorder that can cause above-normal levels of hyperactive and impulsive behaviors.
People with ADHD may also have trouble focusing their attention on a single task or sitting still for long periods of time. Both adults and children can have ADHD.
Complications Associated With Bedwetting
Bedwetting usually does not pose any health risks apart from being frustrating. However, some complications faced by your child could be:
Embarrassment and guilt leading to low self-esteem.
Loss of opportunities such as sleepovers or overnight camping.
Rashes on the genital area if your child sleeps in wet underwear.
Tips to Prevent Bedwetting
Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful.
1. Limit fluids in the evening. It's important to get enough fluids, so there's no need to limit how much your child drinks in a day. But don't limit evening fluids if your child participates in sports practice or games in the evenings.
2. Avoid beverages and foods with caffeine. Beverages with caffeine are discouraged for children at any time of day as caffeine stimulates the bladder.
3. Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep.
4. Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate every two hours.
5. Prevent rashes. To prevent a rash caused by wet underwear, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a protective moisture barrier ointment or cream at bedtime.
While bedwetting in your child can be managed with lifestyle modifications, you should still see a doctor to rule out any possible underlying medical causes.
Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.