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Bed-WettingOverview of bed-wetting Bedwetting, or nocturnal enuresis, refers to the passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is incontinence. For infants and young children, urination is involuntary, meaning they have no control over it. Wetting is normal for them. Most children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first while night-time control comes later. The age at which bladder control is expected varies considerably. Some parents expect dryness at a very early age, while others not until much later. Factors that affect the age at which wetting is considered a problem include the following:
It is assumed that very young children will wet the bed. Therefore, the term "bedwetting" is usually reserved for children (and adults) who are beyond the age at which nighttime bladder control is expected. At age 5, 15-20% of children still wet the bed. Dryness can be expected in most 7-year-old children. Most children simply outgrow bedwetting. The child who wets the bed needs parental support and reassurance. Most of these children will eventually be able to stay dry; they stop bedwetting at a rate of about 15% per year. Bedwetting is a very common problem. Parents must realize that enuresis is involuntary. Bedwetting occurs in both sexes about equally, although some studies have shown it to be more common in boys than girls. About 40% of 3-year-old children and 15-20% of 5-year-old children wet the bed frequently. Although the problem can continue to adulthood, it is by far most common in school-aged children. About 1% of adults have a persistent Bedwetting problem. While we refer to "children" here, it is with the understanding that much of this information also applies to adults with a Bedwetting problem. Bedwetting is usually a treatable condition. While children with this embarrassing problem and their parents once had few choices except waiting to "grow out of it," there are now treatments that work for many children. Several devices, treatments, and techniques have been developed to help these children stay dry at night. Causes of bed-wetting While bedwetting can be a symptom of an underlying disease, a large majority of children who wet the bed have no underlying disease that explains their Bedwetting. In fact, a true organic cause is identified in only about 1% of children who wet the bed. That does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient. There are two types of Bedwetting: primary and secondary. Primary Bedwetting refers to Bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. 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). In general, primary bedwetting probably indicates immaturity of the nervous system. A Bedwetting child does not recognize the sensation of the full bladder during sleep and thus does not awaken during sleep to urinate into the toilet. The cause is likely due to one or a combination of the following:
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 include the following: Urinary tract infection: The resulting bladder irritation can cause pain or irritation with urination (dysuria), a stronger urge to urinate (urgency), and frequent urination (frequency). Urinary tract infection in children often indicates another problem, such as an anatomical abnormality. Diabetes: People with diabetes have a high level of sugar (glucose) in the their blood. The body increases urine output to try to get rid of the sugar. Having to urinate frequently is a common symptom of diabetes. 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 bedwetting. Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination. 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 bedwetting. Children who are being physically or sexually abused sometimes begin Bedwetting. Bedwetting tends to run in families. Many children who wet the bed have a parent who did too. Most of these children stop bedwetting on their own at about the same age the parent did. Symptoms of bed-wetting Most people (80%) who wet their beds, wet only at night. They tend to have no other symptoms other than wetting the bed at night. Other symptoms could suggest psychological causes or problems with the nervous system or kidneys and should alert the family or health-care provider that this may be more than routine bedwetting.
Frequency of urination is different for children than for adults. While many adults urinate only three or four times a day, children urinate much more frequently, in some cases as often as 10-12 times each day. "Frequency" as a symptom should be judged in terms of what is normal for that particular child. Equally important, "infrequent voiding" (less than three times urinating/day) can be a sign of other underlying problems. Treatment for bed-wetting 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 be supportive and reassuring rather than blaming and punishing. The many treatment options range from home remedies to drugs, even surgery for children with anatomical problems. Underlying medical or emotional conditions should first be ruled out. If there is an underlying condition, it should be treated and eradicated. If Bedwetting persists once these steps are taken, however, there is considerable debate as to how and when to treat. Treatment of uncomplicated bedwetting is not appropriate for children younger than 5 years. Because a majority of children 5 years and older spontaneously stop bedwetting without any treatment, many medical professionals choose to observe the child until age 7. The age at which to treat, then, depends on the attitudes of the child, the parents/caregivers, and the health-care provider. Self Care at Home Here are some tips for helping your child stop wetting the bed. These are techniques that are most often successful.
The parents' attitude toward the bedwetting is all-important in motivating the child. Focus on the problem: Bedwetting. Avoid blaming or punishing the child. The child cannot control the Bedwetting, and blaming and punishing just make the problem worse. Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the Bedwetting each time it happens. Enforce a "no teasing" rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the Bedwetting in front of other family members. Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help him or her overcome the problem. The child should be included in the clean-up process. To increase comfort and reduce damage, use washable absorbent sheets, waterproof bed covers, and room deodorizers. Self-awakening programs are designed for children who are capable of getting up at night to use the toilet, but do not seem to understand its importance. One technique is to have the child rehearse the sequence of events involved in getting up from bed to use the toilet during the night prior to going to bed each night. Another strategy is daytime rehearsal. When the child feels the urge to urinate , he or she should go to bed and pretend he or she is sleeping. He or she should then wait a few minutes and get out of bed to use the toilet. Parent-awakening programs can be used if self-awakening programs fail. These programs should only be used at the child's request. The parent should awaken the child, typically at the parents' bedtime. The child must then locate the bathroom on his or her own for this to be productive. The child needs to be gradually conditioned to awaken easily with sound only. When this is done for seven nights in a row, the child is either cured or ready for self-awakening programs or alarms. Bedwetting alarms have become the mainstay of treatment. Up to 70% of children stop bedwetting after using these alarms for 12-16 weeks. About 20-30% start wetting the bed again later (relapse), but with persistence, this method works for 50-70% in the long run. These alarms take time to work. The child should use the alarm for a few weeks or even months before considering it a failure. There are two types of alarms: audio and tactile (buzzing) alarms. The principle is that the wetness of the urine bridges a gap in the sensor, which in turn sets off the alarm. The child then awakens, shuts off the alarm, finishes urinating in the toilet, returns to the bedroom, changes clothes and the bedding, wipes down the sensor, resets the alarm, and returns to sleep. Alarms are preferred to medications for children because they have no side effects. It is generally believed that all children 7 years and older should be given a trial of an alarm. For the alarm to be effective, the child must desire to use it. Both the child and parents need to be highly motivated. Beware of devices or other treatments that promise a quick "cure" for Bedwetting. There really is no such thing. Stopping Bedwetting is, for most children, a matter of patience, motivation, and time. Aromatherapy treatments are not extensive in this area but Cypress essential oil is thought to help due to its antispasmodic, astringent and particularly valuable where there is an excess of fluid. Mix a few drops of the Cypress oil in carrier oil and slowly massage into the abdominal area. Alternatively put a few drops of Cypress oil in the bath. |
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