BedwettingWritten by Marsha Gooden
Bedwetting or Enuresis (en-you-ree-sis) is involuntary urination that occurs at night. Children often wet their bed until they are 5 years old - this is normal. Bedwetting may occur if the bladder is small and cannot store larger volumes of urine; if the child produces a lot of urine; or is not able to concentrate the urine.
Children who continue to have nighttime wetting after the age of five or experience recurrence after being dry for 6 months should be evaluated. There are two types of enuresis – primary and secondary.
Primary Enuresis occurs when a child has never managed to have consistent dry nights for a 6-month period and there is no daytime wetting. It is more common in boys and there is often a hereditary component -there is often a parent who wet their bed past the age of five years. One can usually predict the age when their child might stop wetting based on the age that the parents/relatives attained dryness. These children are often very deep sleepers and do not wake up when their bladder is full.
Primary enuresis usually resolves on its own as the bladder matures. Management consists of limiting fluids before bedtime, voiding (urinating) before going to bed and avoiding caffeinated drinks such as cola. Parents may also awaken their child before the time their child would usually wet the bed and have them empty their bladder. This can become tiresome for the parent. Bedwetting alarms work much better – they detect moisture in the underpants and set off an alarm awakening the child to urinate. Positive reinforcement by praising and making a big deal when there is a dry night and putting stars on a calendar for dry nights. However, do not persist with this if there are no dry nights over a 2-week period as this may act as a reminder of their failure. Do not scold or punish children for wet nights. It may be useful to have close by a change of clothing and bed linen. The child should be allowed to assist in changing the bed linen.
There are medications that may be given if the child is extremely embarrassed and upset with the wetting or is going to summer camp or having a sleepover.
Secondary enuresis is the return of bedwetting after having been dry at nights for six months or longer. The most common reason for this is a urinary tract infection, others include diabetes mellitus, and conditions where urine cannot be concentrated, such as sickle cell disease and diabetes insipidus. These children are often very thirsty and pass large amounts of urine.
Other important causes are emotional stressors such as the birth of a new sibling, death or loss by separation from a loved one, being bullied and sexual abuse.
As parents and caregivers, it is important to remember that bedwetting is involuntary- your child is not doing it deliberately and has no control of it. They should not be punished or teased.
Contributed by Dr. Marsha Gooden, Paediatric nephrologist, UHWI