Bedwetting

Overview

Bed-wetting, also known as nocturnal enuresis, is the involuntary passage of urine during sleep after the age at which a child should be able to stay dry at night. It is a common issue affecting children, particularly those under the age of 7, as they are still developing nighttime bladder control. Bed-wetting can be caused by various factors, including a small bladder, a lack of awareness of a full bladder, hormone imbalances, stress, family history, or underlying medical conditions such as sleep apnea, diabetes, or constipation. It is important to treat bed-wetting with patience and understanding, and lifestyle changes, bladder training, moisture alarms, or medication may help. Bed-wetting without a physical cause does not result in any health risks, but it can cause embarrassment and guilt for the child.

Understanding the disease

Symptoms

The symptoms of bed-wetting include passing urine involuntarily while asleep, also known as nocturnal enuresis. This typically occurs after the age at which a child should be expected to stay dry at night. Bed-wetting can be accompanied by soggy sheets and pajamas, and may cause embarrassment for the child. Other symptoms may include discomfort during urination, pain, or frequent urination during the day. However, it's important to note that bed-wetting without a physical cause does not result in any health risks.

Risk Factors

Several factors have been linked with an increased risk of bed-wetting, including:

1. Stress and anxiety: Stressful events may trigger bed-wetting. Examples include having a new baby in the family, starting a new school, or sleeping away from home.
2. Family history: If one or both of a child's parents wet the bed as children, their child has an increased chance of wetting the bed, too.
3. Attention-deficit/hyperactivity disorder (ADHD): Bed-wetting is more common in children who have ADHD.

Development

Bed-wetting can develop due to a combination of factors, including a small bladder, no awareness of a full bladder, and a hormone imbalance. In some cases, it may also be related to urinary tract infections, constipation, stress and anxiety, family history, attention-deficit/hyperactivity disorder (ADHD), or structural differences in the urinary tract or nervous system. The specific cause of bed-wetting can vary from child to child, and it's essential to approach the issue with patience, understanding, and proper treatment.

Assessment and Diagnosis

Triage

You should see a doctor if bed-wetting is suspected when your child:

1. Is still wetting the bed after age 7.
2. Starts bed-wetting after a few months of being dry at night.
3. Exhibits additional symptoms such as pain while passing urine, excessive thirst, pink or red urine, hard stools, or snoring. These symptoms may indicate an underlying condition that requires medical attention. A doctor can help determine the cause and recommend appropriate treatment options. Remember that bed-wetting without a physical cause does not pose any health risks, but it can lead to guilt, embarrassment, and low self-esteem in children. Patience and understanding are essential when dealing with this issue.

Diagnosis

To diagnose the cause of bed-wetting, a healthcare professional may perform a physical exam, discuss symptoms, family history, and the child's bladder and bowel habits. Urine tests, X-rays, or other imaging tests may be conducted to check for infections or structural issues in the urinary tract. If necessary, other types of urinary tract tests or assessments can be performed to identify the underlying cause of bed-wetting.

Management and Treatment

Complications

Complications of bed-wetting may include guilt and embarrassment, which can lead to low self-esteem. In some cases, bed-wetting may be a sign of underlying issues such as sleep apnea, diabetes, ongoing constipation, or problems with the urinary tract or nervous system. If your child is experiencing bed-wetting and has associated symptoms, it's important to consult with a healthcare professional for proper evaluation and management of any underlying causes.

Home Remedies

Home remedies for bed-wetting are primarily focused on encouraging better bladder control and establishing healthy sleep habits. Here are some suggestions:

1. Encourage regular bathroom trips: Encourage your child to use the bathroom right before bedtime and again in the middle of the night.
2. Reduce fluid intake in the evening: Limit fluid intake, especially caffeine and alcohol, in the hours leading up to bedtime.
3. Use a rewards system: Set up a reward system to encourage staying dry at night. For example, for each dry night, your child can earn a sticker or small treat.
4. Praise and encouragement: Praise your child for their efforts and encourage them to stay positive about their progress.
5. Establish a consistent bedtime routine: Create a calming bedtime routine to help your child relax and prepare for sleep.
6. Limit daytime drinks: Encourage your child to avoid drinking too much during the day, especially in the hours leading up to bedtime.
7. Use absorbent bedding and protective underwear: Use waterproof mattress covers and absorbent bedding to minimize the mess and make cleanup easier.
8. Bladder training techniques: Teach your child techniques like holding their urine for short periods during the day to help strengthen their bladder muscles. It's important to remember that bed-wetting is often a normal part of development and most children outgrow it with time and patience. If the issue persists or is accompanied by other symptoms, consult your child's doctor for further evaluation and guidance.

Treatment

Treatments for bed-wetting may include lifestyle changes, bladder training, moisture alarms, and sometimes medication. Patience and understanding are key when dealing with bed-wetting in children.

Preparing for medical consultation

To prepare for an appointment for bed-wetting, you should make a list of the following:

1. Any symptoms your child is experiencing, including major ones that may seem unrelated to bed-wetting.
2. Key personal information, including any major stresses or recent life changes.
3. Family history of bed-wetting, including siblings or parents.
4. All medicines, vitamins, herbs, and other supplements your child takes and the doses.
5. Questions to ask the healthcare professional, such as:
   • What's causing my child to wet the bed?
   • When might my child outgrow wetting the bed?
   • What treatments are available, and which do you suggest? Are there any side effects?
   • Are there any other options besides the main approach you're suggesting?
   • Should my child limit drinking fluids at certain times?
   • Are there any brochures or other printed material I can have? What websites do you recommend? It's important to be open and honest with the healthcare professional about your child's bed-wetting, as this will help them provide the most effective guidance and treatment.