Bedwetting (nocturnal enuresis) is involuntary voiding of urine during sleep at least three times a week in a child aged 5 years or older. It is a common worldwide problem affecting both boys and girls below 16 years. It can be a distressing experience for the child and may lead to loss of self-esteem and isolation. Children fear being discovered and are afraid to go to relatives’ or friends’ house. Although most parents are supportive, up to 30% parents become intolerant towards their child.
- How common is bedwetting? Can it correct itself?
- Why does bedwetting happen? Is it anyone’s fault?
- Is it caused by any underlying problem?
- What treatment is available? Can any dietary modification help?
- Do’s
- Don’ts
How common is bedwetting? Can it correct itself?
At 5 years of age, around 1 in 6 children still wet the bed. This means that in a school class of thirty there will be five who wet the bed regularly. Because the children and their parents are too embarrassed to talk about the problem it is unlikely that they will be known to each other. Most of these children spontaneously grow out of it. By the age of 10 only one in 15 still wet the bed. Even in adulthood 1 in 100 still suffers from the problem.
Why does bedwetting happen? Is it anyone’s fault?
It is important to remember that it is not the child’s fault. Parents must also not blame themselves. Getting angry or punishing the child could make the problem worse. Supporting and praising the efforts of the child to stay dry will help the child to become dry sooner. Getting medical help relieves the anguish for the family.
The cause of bedwetting is usually a combination of three factors.
- Over production of urine at night
- Hyperactivity of the bladder
- Lack of arousal from sleep
Stressful early life events can trigger bedwetting in those who have previously been dry for a long period.
Is it caused by any underlying problem?
Children with isolated bedwetting usually do not have any underlying problem. However if a child has been wet right from birth, always wet day and night, or never achieved toilet training, then it is essential to see a Paediatric Urologist to make sure that there is no associated medical problem like ectopic ureter, where one kidney drains not into the bladder but, outside the body directly.
What treatment is available? Can any dietary modification help?
Often simple methods like waking up the child (alarms) and giving awards for a dry night (star chart) are undertaken. If bladder over activity is suspected, a bladder relaxing medication is prescribed. If night time alone is a problem, a medicine to reduce the volume of urine in the night is prescribed. When urine infection is suspected, an antibiotic is prescribed.
It is essential to avoid bladder irritants as black current, coffee or coke. Constipation can make bladder problems worse. Taking plenty of fruits and vegetables can help to prevent this. Often parents restrict children’s water intake. This is not necessary; in fact these children need plenty of water and regular toilet visits during the day.
Do’s
- Stay calm, be prepared and try not to worry
- Encourage your child for staying dry; give awards for dry nights
- Encourage the child to drink plenty; it is important that they recognize the feeling of full bladder
- Avoid fizzy drinks, tea, coffee, chocolate; these can irritate bladder and can cause more urine production
- Ensure that the child goes to toilet before bed
- Make sure that easy access to toilet is available at night
- Allow the child to help with changing the bed; this helps them to understand the problem and overcome it.
- Make sure that the child has a bath each morning. This removes the smell of urine and avoids the child being teased at school.
Don’ts
- Do not get cross with your child; it is not their fault
- Do not use waking the child as a long term strategy to overcome bedwetting; instead get help from a doctor.
- Don’t give up. 99% of these children get better by adulthood.
