By Dr Rachna Pande
Bed wetting or nocturnal enuresis is a condition of passing urine in bed while sleeping. It is common in infants and toddlers because bladder control is not developed at that age.
Majority of children gradually acquire control over their bladder function, as they grow. Unfortunately, some children continue to pass urine even when older. They become a source of embarrassment, inconvenience and anxiety for the family. The child himself feels ashamed and loses self esteem. Some continue to have this problem even after becoming teenagers and adults. Apart from the embarrassment caused, bed wetting can lead to infections.
Nocturnal enuresis can be primary, where it is persistent since childhood. In secondary type, a child or adult previously dry develops enuresis sometime later.
Genetic factors are implicated in bed wetting. It is said that if the parents were wetting their bed as children, the child has more than 70% chances of bed wetting. Small size of the urinary bladder leads to bed wetting as the bladder cannot hold much urine.
In some individuals, deficient production of the anti diuretic hormone (ADH), causes bed wetting. This hormone is responsible for reduced urine formation in night and when less in quantity, leads to abundant urine formation in night resulting in bed wetting.
Infections of the urinary bladder and urethra can lead to urinary incontinence and bed wetting. Injuries, infections or tumors of the spinal cord or brain result in bed wetting at any age, due to damage to the nerve fibers controlling the bladder. They also cause incontinence in the day time. Similarly stroke cause damage to the bladder control center resulting in nocturnal enuresis.
Advanced cases of prolapse of the uterus in middle aged or elderly women can lead to enuresis. Some cases of chronic severe constipation can result in bed wetting as the full bowel presses upon the urinary bladder.
People suffering from severe depression or psychological problems may wet their beds in night.
Whatever the cause for nocturnal enuresis, it is a very disturbing problem. The parents usually become restless and anxious if by 3 or 4 years of age, the child still passes urine in bed. But they should be patient. Some children develop good control over the bladder only by 4 or 5 years of age. Variations in age can occur, when a child attains bladder control.
In case of secondary enuresis, it is important to get the individual investigated to seek the cause of bed wetting. Treatment by either drugs or surgical intervention usually helps the individual to be rid of the problem. There are drugs available to treat primary enuresis.
Restricted amount of fluids should be given to the individual suffering from enuresis in the evening. Ideally, no fluids should be given 2 hours prior to sleeping. This will ensure him to be dry for the night.
Bladder training is very helpful in cases of nocturnal enuresis. A child or an adult with the problem should be woken up at a fixed time every night and taken to the toilette. Gradually, the urinary bladder will be trained to void at that fixed time. Thus the individual can wake up at that time on his own, pass urine in toilette, thus avoiding bed wetting.
Irrespective of the age of the person having enuresis, it is important for the caregivers to see that s/he remains dry and clean. The family should not make him feel ashamed. His morale and self esteem should be kept high.
Though troublesome, bed wetting is a problem which can be solved very well with patience, proper diagnosis and treatment.
Dr. Rachna Pande
Specialist internal medicine
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