Is bedwetting normal?
This is a frequently asked question by anxious parents with kids regularly wetting bed at night. Kids and bedwetting is a combination that continues to be a challenge to treat for doctors as there is no specific cause found in majority of the cases. Children learn to control their bladder during the day by 4 years of age. Nighttime bedwetting up to 5 years is not abnormal either. However, beyond this age, bedwetting becomes a stressful and embarrassing situation for both, the child and parents. Night wetting stops without treatment in most kids as they grow. The rate of bedwetting decreases with age by 16% at 5 years, 5% at 10 years and 1-2% in 15 years and above.
Nocturnal enuresis in children
Nocturnal enuresis is the medical term for bedwetting. It refers to the involuntary passage of urine in children that occurs irregularly at night. Night wetting in children for more than 2 nights in a week for 3 successive months is commonly seen in children between the ages of 5 to 7 years.
Around 80% children with frequent bed wetting at night never experience significant consecutive dry nights. They also do not suffer from any other symptoms during the day like urgency to pass urine, inability to control urine, increased frequency, or burning sensation while passing urine. This condition is known as primary nocturnal enuresis or primary bedwetting.
Secondary enuresis or secondary bedwetting is a condition in which the child does not make the bed wet for 6 months before the reversal of symptoms.
In few kids, nocturnal urination is present along with symptoms like urgency, frequent urination, or burning sensation while passing urine during the day.
What causes a child to wet the bed at night?
Different causes have been identified for toddler bed wetting.
1. History of childhood bed wetting among family members increases the chances of nocturnal enuresis in children. There are 44% chances of a child developing nocturnal enuresis if one of the parents had a similar childhood history.
2. Bedwetting is more common in toddler boys than in girls.
3. Long-standing constipation has been observed to cause night wetting in children.
4. Insufficient secretion of the hormone vasopressin in the body increases the production of urine at night, which leads to involuntary bedwetting.
5. Bedwetting is commonly seen in toddlers that stay in day-care or are looked after by guardians other than parents. Emotional stress plays a significant role in causing nocturnal enuresis in toddlers.
6. Decreased urine holding capacity of the bladder or increased contraction of bladder muscles can cause involuntary passage of urine at night.
7. Child keeps wetting the bed at night because he/she is not able to wake up when there is an urge to pass urine.
8. Other causes include diabetes, urinary tract infections, spinal cord abnormality, structural defects in the bladder or urethra, sleep apnea, intestinal worms, involuntary passage of stools, etc.
Management of bedwetting in young children
Bedwetting stops as the child grows in majority of the cases. Non-medical line of treatment plays a key role in kids’ bed wetting problem. Medicine for nocturnal enuresis is not recommended before 7 years of age.
A detailed history of the symptoms, family history, other illnesses will be taken by the pediatrician. Physical examination of the child along with the lab tests may be required in severe cases.
Non-medical ways to help your child stop wetting the bed:
1. Avoid scolding or punishing the child for night wetting, as it is not his/her fault. In fact, it can cause behavioral issues and worsen bed wetting in the child.
2. Motivate the child for passing urine 4 to 7 times in a day along with exercises that improve in bladder control and capacity.
3. Encourage kids to wake up at night to pass urine.
4. Maintain a log of dry nights and reward the kid at the end of.
5. Restrict caffeine in kids after evening.
6. Restrict water intake 2 hours before going to sleep.
7. Bedwetting alarm is an effective way of treating primary night enuresis in kids. It involves use of bed pads, bed bells, and oscillators. Bed wetting sensor is placed on bed; it vibrates or makes sound in increasing intensity when the bed becomes wet. Alarm trains the child to hold the urine at night and wake up for urination before it is passed involuntarily. The device is useful to stop bed wetting at night in children above 7 years. Bedwetting alarm is the best way to stop bedwetting in kids as it has long-lasting effects. However, this requires significant patience and support from parents.
8. Treatment of chronic constipation, if any, solves the problem of bedwetting in kids below 5 years in majority cases.
9. Desmopressin, an artificial preparation of the hormone vasopressin, is used in older children and teenagers who do not respond to alarm therapy. Results are visible soon after starting treatment but there are high chances of recurrence after stopping the medicine. Nasal spray for bed wetting also contains desmopressin, which is used at night before the child goes to bed.
10. Anticholinergic medicines are given to decrease the contraction of bladder muscles in children who do not respond to alarm therapy and desmopressin.
Disclaimer: The information in the article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor.
Also read: Ways to handle Bedwetting by children