• 29Apr

    What causes bed wetting in children?

    Bed wetting or enuresis is defined as incontinence of urine during sleep. During the day, the control of urine is normal. Bed wetting is normally seen in children up to the age of 3 years. It is abnormal after the age of three years. It is seen in 15% of children at the age of 5 years and 1% if the children at age 15. 


    Causes of bed wetting in children

    There are various causes of bed wetting. In 50% of cases, there is delayed maturation of the nervous system or the nerve supply to the urinary bladder. A psychological cause has been found in about 30% and the remaining 20% cases are due to disorders of the urinary bladder. Most of the children achieve a control of their urination by the age of ten years. It has also been proposed that many children suffering from bed wetting have an increased production of urine at night. The imaging studies (ultrasonography) have shown that the urinary bladder capacity of these children may be reduced or normal. Bed wetting may be a manifestation of attention seeking phenomenon in case of birth of a younger sibling. It has also been found that arousal from sleep is difficult in these patients, and more in boys than girls. Delayed maturation of bladder function is responsible in a fraction of patients.

    Bed wetting is normally seen in children up to the age of 3 years.

    Bed wetting is normally seen in children up to the age of 3 years.

    Bladder training

    The bladder training of a child is recommended after the age of one and a half years. Attempts of training before this age usually fail and may be harmful to the child. Any undue pressure exerted by the parents may result in mental tension in a child, and inability to achieve cerebral (related to brain) control over bladder.

    Features

    Bed wetting may occur daily or occasionally. A normal volume of urine is passed without the child waking up during the act. The urine is usually clear and without any burning sensation or fever. The results of urine examination and imaging of urinary bladder by ultrasonography are usually normal.

    These children feel even more disturbed when they start going to school. They find it difficult to stay overnight at their friend’s place (no night – outs) because of social fear of their bed wetting habit. They may then become introverted. Any punitive action by their parents may aggravate bed wetting.

    Treatment

    If the habit of bed wetting continues beyond the age of three years than a physician consult is required.

    Behavior modification - at the level of parents, they should follow some of the general principles of management and ensure cooperation of the child.

    • The child should not be given fluids like a glass of milk immediately before going to bed at night.
    • The child should be taught to go to the toilet daily before going to bed. That will ensure an empty urinary bladder before sleeping.
    • An observation by the parents will indicate the usual time of bed wetting at night. They should wake up the child daily, before the usual time of bed wetting so that the child can pass urine in the toilet.
    • The child should be suitably rewarded for keeping dry at night. A daily charting can be done to keep a track and positive response (dry nights) should be highlighted.
    • Punishment or humiliation by the parents should be discouraged.

    Drug therapy -  when the general measures fail to control bed wetting, drug therapy should be added. 

    • Imipramine is a tricyclic antidepressant and is commonly used for treatment. It is successful in curing 50–70% of patients and is considered the drug of choice. The usual dosage is 25 mg given before dinner. If required, it may be increased up to 50 mg.
    • Desmopressin may also be used for treatment.

    Bed wetting in normal until the age of three. After that time, parents should do their best to help their child overcome this habit. In case of no fast results, a physician should be consulted.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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