A wide eyed, red faced child hurriedly trying to yank out a wet sheet off the bed is a common sight to behold in the mornings. Bedwetting is a common problem often causing considerable distress to the child and his family. Most children are toilet trained between the ages of 2 and 5. Many children at this age are able to stay dry during the day, but lack nocturnal control until they are older. More than 85% of children have complete diurnal and nocturnal control by 5 years of age. Between 15 to 30% of 6 year olds have one episode of bedwetting (also called enuresis) per month, and as many as 4% or more 12 year olds are wetting their beds some of the time. Like so many things in paediatrics, bedwetting and the issues associated with it have their own developmental time line. Read on to get a perspective of all you need to know about nocturnal enuresis after the 5th year of life.
Causes of bedwetting
There is no single underlying cause for this enuresis, and the condition may be multifactorial.
• Nocturnal polyuria - Your child's body makes a lot of urine at night.
• Bladder capacity - Your child's bladder is small.
• Increased arousal threshold - Your child is in a deep sleep and does not awaken to the signal of a full bladder.
• Your child has constipation.
• Your child is reacting to a stressor.
• Your child has an underlying medical problem. Signs of a medical problem include pain, burning or straining while urinating, a narrow stream, altered urine color, poor bowel control, urinating after stress, daytime and night time wetting, problems with walking and mood/personality changes.
Managing bedwetting
The key to managing bedwetting is motivational therapy and behavioral modification. Timely therapy prevents psychological damage to the child. General advice should be given to all bedwetting children but active therapeutic intervention should not begin before the age of 6 years. No single therapeutic plan is ideal for all children. The final choice is best left to the child and parent. Here are a few sensible pointers to adhere to.Be honest with your child about what is going on and that the likely cause is maturational delay. Assure the child that eventually he/she will be able to stay dry all night.Be sensitive to your child's distress and do not make a big deal out of it.Let your child help. Encourage your child to change wet sheets or put a plastic cover under the sheets to protect the bedding. This will instill a sense of responsibility and also ward off embarrassment.Take steps before bedtime. Avoid large quantities of fluids before bedtime. Avoid caffeine, carbonated drinks and citrus juices before bedtime. Have your child use the restroom before bedtime.Wake the child 2 to 3 hours after going to sleep. Reward the child for a dry night.If the above conditioning methods do not work even after patient reinforcement for 3 months, your pediatrician may recommend the use of bedwetting alarms. This system senses a urine leak and sets off an alarm that will arouse the child. This is successful in about two-thirds of children. All said and done, the ordinary alarm clock may be used to wake up the child at the critical time.
Role of drugs: Different medicines are available to treat bedwetting. These must be considered in children over 5 years whose bedwetting persists despite use of alarm, regular voiding habits, treatment of constipation and exclusion of underlying medical problems. These medicines come with their set of side effects and need to be administered under parental supervision.
Consult your paediatrician for further assistance in this regard and to know what is right for your child.
Remember, there is no reason to feel distressed or embarrassed. It is a part of growing up.Happy Parenting!