Bed wetting or Enuresis is a psychosomatic disorder. Its an emotional disturbance causing dysfunction of organs controlled by autonomic nervous system. Many children with this disorder also have behavioural disorders. Such children are usually timid and nervous. By age 5, one in five still wets the bed and at age 6, the numbers drop to one in 10. Boys are more likely than girls to wet their beds.
Stages of Bladder Control in children
- At 6 months – the child usually wakes up before wetting.
- Between 12 and 18 months the child urinated when placed on the pot.
- After 2 years the child is capable of retaining urine even when the bladder is full.
- At 3 years – the child goes to the toilet, takes off this clothes and passes urine.
- At 5 years – the child can empty the bladder even when its not full.
It is also suspected that bed-wetting may be caused by slow development of the nerves that control the bladder. Among other less common causes is Small Bladder. Even a small bladder unable to hold the urine produced during the night can result in bed-wetting. Bed-wetting can be a symptom of a serious illness (e.g., diabetes or a urinary tract infection), especially if it starts in a child who has previously been dry through the night.
Large majority of children who wet the bed have no underlying disease. In fact, a true organic cause is identified in only about 1% of children who wet the bed.
Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months). Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting.
Common causes of secondary bedwetting are:
- Urinary Tract Infection
- Structural or anatomical abnormality: An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence or other urinary problems that could show up as bed wetting.
- Emotional problems: A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bed wetting.
- Pinworm infection: characterized by intense itching of the anal and/or genital area.
It is probably a good time to seek medical help when the child is 5-7 years of age.
Bedwetting is typically seen more as a social disturbance than a medical disease. It creates embarrassment and anxiety in the child and sometimes conflict with parents. The single most important thing parents can and should do is to be supportive and reassuring rather than blaming and punishing. Primary nocturnal enuresis has a very high rate of spontaneous resolution.
- Your patience and love will go a long way to help a child who wets the bed. Making the child feel guilty, getting angry or acting disgusted will only delay solving this problem. Try to be understanding and supportive.
- Set an alarm clock two to three hours after your child falls asleep so he or she can be awakened to go to the bathroom.
- Make sure your child urinates before getting into bed.
Desmopressin, Imipramine, Oxybutynin and Hyoscyamine
Desmopressin acetate is a synthetic form of antidiuretic hormone (ADH), a substance that occurs naturally in the body and is responsible for limiting the formation of urine.
Imipramine is a tricyclic antidepressant that has been used to treat bedwetting for about more than 30 years. How it works is not clear, but it is known to have a relaxing effect on the bladder and to decrease the depth of sleep in the last third of the night.