"My Child Is in School and Still Wets His Bed!"

We often encounter quite grown-up children who still wet their beds at night (some of the ones reading this might have suffered themselves during their childhood; heck, even the one who is writing this was once a bed-wetter. Sorry! No shame in admitting that as 1 in every 5 child suffers from it).

Bed-wetting or "Nocturnal enuresis" in medical terms, is associated with guilt in the children suffering from it, and anxiety in parents of such children.

A child usually gains bladder control by 2-3 years of age, so the parents of a child who is still wetting his beds at night at 4 or 5 years of age would obviously be very concerned.

Even the child knows that by now he should not be wetting beds as he/she already has adequate bladder control during daytime.

However, it is quite a common condition with almost 20% of all school-going children suffering from it.

When to see a doctor?

Bed-wetting is quite normal in small children as it takes some growing up to do before the child gains full control of his/her bladder.

80-85% of children stop bed-wetting totally by 5 years of age.

You need to consult a pediatrician only if the child is 5 years or older and is still wetting beds at night during sleep.

Primary & Secondary enuresis

Primary enuresis is when the child has never been dry at night till now whereas secondary enuresis is when the child has been dry for at least 6 months continuously but now has started bed-wetting all over again.

This classification is important as kids with secondary enuresis are more likely to have urinary tract abnormalities.

75-90% of cases are primary enuresis.

Monosymptomatic & Polysymptomatic enuresis

Monosymptomatic enuresis is when the bed-wetting occurs as an isolated problem without other urinary complaints.

Polysymptomatic enuresis on the other hand is associated with other urinary problems such as increased frequency of passing urine throughout the day, increased urgency, and daytime incontinence too.

Monosymptomatic enuresis is more common than polysymptomatic enuresis. Polysymptomatic enuresis is associated with urinary tract abnormalities.

What causes Nocturnal enuresis?

Primary nocturnal enuresis, or only night-time bed-wetting during sleep, has many causes- delayed maturation of bladder control, sleep disorders, psychological stressors in family, and genetic factors.

It is more common in boys and 50% of children have a parent who had the same problem as a child.

Secondary enuresis can be due to some underlying disease/abnormality like diabetes mellitus, urinary infections, diabetes insipidus, and urinary tract abnormalities.

How is Nocturnal enuresis treated?

The first treatment is "reassurance".

Primary nocturnal enuresis is a self-limiting condition and it stops by itself in 15% of cases every year all by itself.

Hence, punishments should be avoided as they will have a long-term impact on the child's confidence and psychological development.

The following measures can be taken by the parents for children <6 years age.

• Restrict fluid intake to less than 100ml after 7 pm.

• Avoid tea, coffee, and extra sugar after 5 pm.

• Make the child void urine just before bedtime.

• Wake the child up to void 3-4 hours after sleep.

For children >6 years age, along with the above measures, the following treatment can be tried

• Motivational therapy- keeping a star-chart for dry days and rewarding the child for dry nights

• Alarm therapy- a loud alarm attached to a vibratory sensor in the underwear of the child which wakes the child up when voiding starts

Secondary enuresis needs treatment of the underlying disorder like Diabetes, Urinary infection, etc

Final words

To conclude, my message to all parents who have a child with nocturnal enuresis is that they should not be too harsh on the child as this condition improves with age as the child gains more bladder control.

If unable to control the situations with the above home measures - do go and consult a pediatrician- as some tests might be required to rule out an underlying disorder.

If you have any queries or confusion regarding nocturnal enuresis, please feel free to comment below.

Regards,

Dr. Zeeshan

Click here to know more about me.