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Bed-wetting

Definition


Disease: Bed-wetting Bed-wetting
Category: Psychiatric diseases
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Disease Definition:

Bed-wetting is the involuntary urination at night.
Also known as nocturnal enuresis or nighttime incontinence, bed-wetting usually isn’t a sign of toilet training gone bad. It is usually only a developmental stage.

A child has primary enuresis when he/she has never been dry at night.
A child has secondary enuresis when he/she begins to wet the bed after at least six months of dry nights.

Before the age of 6 or 7 nighttime bladder control simply may not be established, so bed-wetting before that age isn’t a cause for concern.

Bladder training, moisture alarms or some medications could help this condition. But if the problem continues, parents should treat it with understanding and patience.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Although there’s no target date for developing complete bladder control, but most kids are fully toilet trained between the ages of 2 and 4. About 40% of preschool children wet their beds, but bed-wetting remains a problem only for 10-15% of children by the age of 5.

Causes:

The real reason of bed-wetting is not known, however, there are several factors that contribute to it, such as:

Urinary tract infection:
Urination could be difficult to control with a urinary tract infection. Bed-wetting, frequent urination, pain during urination and daytime accidents are some of its signs and symptoms.

A small bladder:
In some cases, the child’s bladder might not be developed enough to hold urine produced during the night.

Stress:
Bed-wetting could be triggered by stressful events, such as starting a new school, becoming a big brother or sister, or sleeping away from home.

Sleep apnea:
Sometimes, obstructive sleep apnea could cause bed-wetting. This condition occurs when the child’s breathing is interrupted during sleep, usually due to inflamed or enlarged tonsils or adenoids. Frequent ear and sinus infections, daytime drowsiness, sore throat and snoring are some of its other signs and symptoms.

A hormone imbalance:
In some cases, some kids don’t produce enough anti-diuretic hormone or ADH during childhood to slow nighttime urine production.

Diabetes:
Bed-wetting could be the first sign of type 1 diabetes for a child who’s usually dry at night. Increased thirst, weight loss in spite of a good appetite, fatigue and passing large amounts of urine at once are some of the other signs and symptoms.

Anatomical defect:
In some very rare cases, bed-wetting could be related to a defect in the child’s urinary or neurological system.

Inability to recognize a full bladder:
A full bladder may not rouse the child from sleep if the nerves that control the bladder are slow to mature, particularly if the child is a deep sleeper.

Chronic constipation:
In some cases, when children don’t have regular bowel movements, they retain urine as well, which leads to bed-wetting at night.

Complications

Complications:

Bed-wetting without a physical cause doesn’t pose any health risks. However, the guilt and embarrassment a child feels about wetting the bed could lead to low self-esteem.

If the child sleeps in wet underwear, rashes on the bottom and genital area could be an issue. Parents should help their child in rinsing his/her bottom and genital area every morning in order to prevent a rash. However, covering the affected area with a petroleum ointment at bedtime could also help.

Treatments:

Double voiding, which is urinating at the beginning of the bedtime routine and then again just before falling asleep, along with limiting fluids before bedtime could help.

In case there’s a family history of bed-wetting, the child is likely to stop at the age the parent did. Most children outgrow bed-wetting on their own.

If the bladder isn’t completely full, the urge to urinate might fade within a few minutes, and so parents may want to encourage their children to delay daytime urination, because this simple “stretching exercise” could help the child’s bladder hold more urine at night.

A more aggressive treatment could be recommended if the child is 7 and still wetting the bed, but is motivated to stop.

Moisture alarms:
These alarms are small, battery-operated devices, which are available without a prescription at most pharmacies. This device connects to a moisture-sensitive pad on the child’s pajamas or bedding, so that when the pad senses wetness, the alarm goes off. Just as the child begins to urinate, the moisture alarm should sound, in proper time to help the child wake, stop the urine stream and get to the toilet. However, another person might need to listen for the alarm, in case the child is a heavy sleeper.
The moisture alarm is quite effective, but it takes some time. Usually, to see any type of response the parent have to wait two weeks, and to enjoy dry nights, they have to wait 12 weeks. These moisture alarms provide a better long-term solution than medication does.

MEDICATIONS:
The child might be prescribed some medications to stop bed-wetting in case the other options fail. These various types of medications can:

Change a child’s sleeping and waking pattern:
By changing a child’s sleeping and waking pattern the imipramine  antidepressant could provide bed-wetting relief. The amount of time a child can hold urine can be increased by this medication, or the amount of urine produced can be reduced. Caution is essential because imipramine has a few side effects for bed-wetters and an overdose can be fatal.

Slow nighttime urine production:
The levels of a natural hormone called anti-diuretic hormone (ADH) can be boosted by the drug desmopressin acetate (DDAVP), which forces the body to make less urine at night. This medication is available as a pill or nasal spray. However, as of December 2007 only the pill form is approved to treat bed-wetting. DDAVP has a few side effects. When the medication is accompanied by too many fluids, it could cause seizure, which is the medication’s most serious side effect.

Calm the bladder:
Anticholinergic drugs, such as hyoscyamine  or oxybutynin  can help in reducing bladder contractions and increasing bladder capacity, in case the child has a small bladder. Dry mouth and facial flushing are some of its side effects.

In some cases, the most effective treatment is a combination of medications. However, there are no guarantees; medication doesn’t cure the problem and bed-wetting resumes when the medication is stopped.


Some of the helpful treatments for bed-wetting include hypnosis, acupuncture and massage. However, before such therapies can be proved effective, more research is needed.

Prognosis:

Not available

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