It is estimated that 15-20 percent of children age five and five percent of children age 10 are affected by Nocturnal Enuresis. It’s defined as unintentional night urination or night bed wetting in spite of the child exceeding the age at which he/she is supposed to be capable of controlling bladder function during sleep.
Bed wetting occurs in both sexes, though boys are more prone than girls to wet the bed. Bed wetting makes children feel isolated and ashamed and sometimes they become subjected to ridicule and mockery for something for which they have no control.
Frequently, children will be excluded from participating in fun activities like school trips, exploratory camps and visiting relatives to spend a night. Many studies show that nocturnal enuresis can badly affect a child’s self-esteem, confidence, socialisations and education. In fact, it has recognised negative effects on the family as a whole. Care must be taken to assure young, developing children that bedwetting is not their fault and that there are some tools available to help them.
What are the reasons for bed wetting?Contrary to popular belief, bed wetting is not caused by any mental or behavioral problems. Neither is it caused by deep sleep. Parents often believe laziness is the cause of bed wetting; this, in fact, is not correct. Bed wetting can be the result of any one of several unrelated problems. Normally the kidneys produce a continuous stream of urine, which ends up in the bladder. As the bladder fills it gradually becomes stretched and eventually signals the brain that we have a need to urinate.
This feeling of urgency should be familiar to us all. In addition, during sleep the brain produces a hormone called vasopressin which reduces urine output from the kidneys, usually to a level where the bladder does not fill completely until we are awake. If, when we are asleep, the bladder does fill and our brain fails to recognise the sense of urgency for what is happening, then the bladder has no alternative but to relax the pelvic floor muscles and open the floodgates.
The good news is that as children grow, their brains naturally increase production of vasopressin, although for some the effects might not kick in until puberty.
Other possible reasons for bed wetting:
• Genetics. Yes, it can run in the family
• Urinary tract infections.
• A small bladder, which can make it difficult to hold urine for a long time
• Overactive bladder
• Stress. If your normally dry child suddenly starts wetting the bed, there’s a good chance it is stress related.
• Hormones. Not having enough of the anti-diuretic hormone that lowers the amount of urine produced by the kidney can cause problems (mentioned previously)
• Any abnormalities in the spinal cord, urethral valve (boys) or ureter (boys and girls)
When should you consult your doctor?
• When the child reaches five years old and is still bedwetting
• When the symptoms occur during the day/night or both
• When the child is six months dry and then bedwetting recurs
At the The City Hospital’s Enuresis Clinic, our doctors use a comprehensive, medically based approach that can deal with daytime and nighttime wetting in children, teens and adults. A careful history, physical exam, and urine test can usually determine the type of bed-wetting and the best treatment approaches.