Bedwetting is the release of urine while sleeping . The medical term for bedwetting is nocturnal enuresis << `EHN` yu REE sihs >> . As children gain control over their body functions, they are first able to hold their urine during the day. Over time, they gain the ability to hold their urine at night, while sleeping. Most children gain control of urination during sleep by the age of 5 years. Doctors generally do not consider bedwetting to be a problem before that age.
Doctors describe bedwetting as either primary or secondary. In primary bedwetting, the child has never been dry at night for any prolonged period. Secondary bedwetting develops after the child has been dry at night.
Causes.
Bedwetting has several causes. A child may produce more urine at night than the bladder can hold. This situation may occur when a child drinks liquids close to bedtime. Less often, it can occur with diseases such as diabetes mellitus or a rare condition called diabetes insipidus. These diseases affect how the body makes important hormones. They can thus cause the kidneys to produce large volumes of urine.
In other instances, a child’s bladder may not be able to hold a normal amount of urine. Normally, the bladder is able to relax and hold fluid until it gets full. As the bladder stretches, bladder muscles send signals to the brain. These signals let the child know that the bladder is getting full and that it is time to empty it. The bladder is emptied when muscles contract and the pelvic floor (bottom of the lower abdomen) is relaxed. Sometimes, the bladder muscles contract on their own, and even if the bladder is not yet full, it cannot relax enough to hold urine well. Other times, the bladder cannot expand because structures outside the bladder prevent it.
Bedwetting also occurs when signals that the bladder is full are not recognized by the brain during sleep. These signals thus fail to awaken the child, which may lead to urinary leakage. In some cases, this problem can be accompanied by a loss of muscle tone during sleep. This can make holding urine in the bladder more difficult. Children who are sound sleepers may not awaken in response to the need to empty the bladder. Snoring is associated with bedwetting in some children.
Treatment.
A doctor will begin treatment for bedwetting by discussing why treatment is being sought and what goals the parent and child hope to accomplish. Experts recommend that treatment should not be undertaken in children who are not bothered by their bedwetting and that dry nights should not be achieved at the expense of good sleep and elimination habits. Doctors review the child’s intake and elimination habits as well as the times that the child goes to bed and wakes up. A physical examination and review of medical history can identify any medical reasons for bedwetting.
The initial step in treating bedwetting is to adopt good elimination habits . Doctors encourage children to go the bathroom upon awakening, regularly throughout the day, and just before bed. Children should drink enough fluid during the day so that the urine is light yellow in color. They should also limit fluids beginning two hours before bedtime. Such measures even taken alone can produce a marked improvement in bedwetting.
Children who continue to experience bedwetting may use a bed alarm. Some bed alarms clip to the underwear, while others are placed on the bed for the child to sleep on. In either case, the device sounds an alarm in response to wetness. The child can then awaken and go to the bathroom. Such an alarm is most effective when used correctly in motivated children who have adopted good elimination habits. Doctors may also prescribe medications to treat bedwetting. The two most common such medications are desmopressin (abbreviated DDAVP) and imipramine. Desmopressin works by preventing the kidneys from making too much urine. Some medical experts think imipramine affects bladder functioning and the sleep cycle in ways that help patients awaken before emptying the bladder. Patients should continue practicing good elimination habits even when taking medication. Bedwetting may return when the medication is stopped.
The doctor and family should work together to decide the best treatment for a particular child. Experts stress that it is very important for parents and children to realize that bedwetting is not the child’s fault and should not be punished.
