Bed-Wetting

BEDWETTING (Nocturnal Enuresis)
Bladder control & Epidemiology
Most children are able to control their bladder, during sleep, by the age of five years. However, 1:5 five-year old kids, wet their beds at night; 1:10 five-year old kids wet themselves during the day, at least once every 2 weeks. By the age of 10 years less than 1:20 kids wet their bed at night. Daytime wetting is more frequent in girls; night time bedwetting is more common among boys.

About 2 % of teens, wet their beds during sleep.
About 1-2 % of Adults wet their beds at night
Bedwetting is most common in children, and in some Stressed Adults too.

Definition
When a person, older than 5 years, voids urine in bed or on their clothes, at least twice in a week, for 3 consecutive months, they are said to be bed-wetting

There are two types of bed-wetting: Primary (child has never had a period of dryness since birth) and Secondary in which the child has had 3 months of sustained dryness during daytime, and 6 months of bedtime dryness.

Causes
a.) Heredity: Bed-wetting tends to run in families. If both parents used to wet their beds, 3:4 of their children, shall have bedwetting issues; if only one parent had the bedwetting history, 2:5 of their kids shall wet their beds during sleep. Apart from genetic predispositions, there may be other medical causes. The list could be long

. Bladder dysfunction: Overactive Bladder (bladder frequently contracts to expels urine, even if not distended)

. Increased urine production at bedtime
. Persons who Fall into deep sleep, and are difficult to arouse from their sleep

. Persons with Sleep Apnea tend wet their beds
. Those with Anatomical problems in their urinary tract (ectopic ureter)

. Emotional Stressful situations
. Sickle Cell Kidney disease
. Constipation (bulky stools in the rectum decreases bladder volumes)

EVALUATION
URINE ANALYSIS: Urine examination is the first step in evaluating for nocturnal enuresis

. Presence of WBCs and Bacteria in the urine, predicts bladder and urinary tract infections.

. Presence of RBCs and proteins in the urine predicts Kidney diseases

. Urine with low specific gravity predicts diabetes insipidus (inability to concentrate urine) or the person intentionally, drinks too much water

TREATMENT
Most kids 5 years and younger stop their bed-wetting on their own and they therefore, require no treatments.

Treatment is available for those who are 6 years and older.

Successful treatment requires a well-motivated child and a Cooperative and Supportive Family.

1. Conservative measures. These include

. Decreasing fluid intake several hours before bedtime

. Child Voids urine just before they go to bed, and just before the parents go to bed

2. Bed-wetting Alarms

The child wears a moisture sensor in their underwear/pajamas. The sensor triggers an audible alarm when it senses urine in the underwear/pajamas. The alarm wakes the child up. When used consistently, bed-wetting alarms are the most effective interventions against bed-wetting. Typically, the alarm is worn at bedtime for 2-3 months or until the child stays dry for 2 continuous weeks.

3. Medications

. Desmopressin (DDVAP). Desmopressin is the most often used medication for bed-wetting. It helps the kidneys to reabsorb more water, and thus reduce the volume of urine production. It is given at bedtime. It may take 2-3 months to see results.

. Oxybutynin: Relaxes the bladder muscles and therefore useful for those with overactive bladders.

A combination of conservative measures, Bed-wetting alarms and medications often solve bed-wetting problems.

Those who do not show improvement, despite adhering to treatment recommendations could be referred to Bladder, and /or Kidney Physicians.