Bed Wetting is known as Nocturnal enuresis in medical term. It is very common problem seen in children until they are 5 or even older.
Enuresis means repeated voiding of urine into the bed or clothes at least twice per week for at least three consecutive months in a child who is 5 years old or more than that. It is seen that some children sleep too deeply or take longer to learn bladder control. Reason behind bed wetting is that a child’s bladder might be too small, or it the amount of urine produced overnight can be more than the bladder can hold.
Enuresis is also seen when frequency or duration is less. It is sometimes associated with distress or functional impairment. There is more chances of bed wetting in a child who has at least one sibling, parent or extended family member such as aunt, uncle or grandparent who also wet the bed after the age of 5.
True bedwetters do not waken after wetting. Bed wetting has nothing to do with dreaming. Wetting the bed is quite unconscious. Child has no memory that he has pass urine in bed.
Some children who wet bed at night also have some trouble in working of bladder works through the day. They may go to the toilet too few or too many times. They need to rush to the toilet in a hurry. They have trouble emptying out all the urine or have bowel problems.
Diurnal enuresis means child wetting while awake.
Types of Bedwetting
- Monosymptomatic enuresis (MNE) means child has enuresis without lower urinary tract symptoms and without a history of bladder dysfunction.
- Non-symptomatic enuresis (NMNE) means child has enuresis with lower urinary tract symptoms.
Enuresis can be classified as-
- Primary enuresis: when child who are never been dry in night.
- Secondary enuresis: When child has resumption of wetting after at least 6 months of dryness.
Occurrence of disease:
Nocturnal incontinence occurs in 12% to 25% of 4-year-old children, 7% to 10% of 8-year-old children, and 2% to 3% of 12-year-old children It may be problematic even in late teenage years (1% to 3%) and if untreated enuresis (especially if severe) can persist indefinitely with prevalence rates of 2%-3% in adulthood.
Primary enuresis is twice as common as secondary enuresis. It is more common in boys 2:1. It is seen that this problem is more difficult to treat in boys. Majority of children has primary nocturnal enuresis. Those who have secondary enuresis may be due to following reason-
- Stress in life like parental divorce, birth of sibling
- School trauma
- Sexual abuse
Causes of Bed Wetting
Genetics: It is seen more when either of parents or both parents are enuretic their child can also have a problem of enuresis.
Sleep pattern: Children with severe enuresis were light sleeper, but they did not wake before voiding. The arousal centre may be suppressed in these children. Also, in these children overactive bladder is also seen. Enuresis is also associated with snoring.
Maturational delay: Sometimes it is seen delayed maturation of a normal developmental process. In children who have late in walking and talking can have problem of enuresis. Bladder capacity at birth is only around 60 ml and thereafter increases with age. Children with nocturnal enuresis have been noted to have a smaller bladder capacity (functional rather than anatomical) even when there are no day time concerns.
- Bedwetting occurs when children fails to wake up when their bladder is full at night and the bladder automatically releases the urine.
- It is caused by laziness or a desire to get attention.
- Nocturnal polyuria: Child with increased fluid intake before will have increase urination.
- Children who wet produce more urine at night than others. This is because they have low level of a hormone which controls how much urine is made. It is controlled by brain.
- Sometimes bed wetting is seen when child sleeps in a strange place. They may be bit worried when sleeping away from home.
Warning Signs Along with Bedwetting
- Child is ill or feverish.
- Urine dribbles day and night.
- Pain along with urination.
- Help of a doctor should be taken when child reaches 5 and half.
- If child who has been dry suddenly starts wetting at night.
- The wetting is frequent after school age.
- Wetting bothers the child or makes them upset or angry.
- The child wants to become dry.
How to Prevent Bed Wetting
- Parent should encourage their child to awake in order to void during the night.
- Lifting: Involves taking the child to the toilet during the night usually before the time that bedwetting is expected, without necessarily waking the child.
- Bladder training program is good habit: In this training child learns to a be a good drinker and to empty their bladder well when they need to go to the toilet. This prevents sudden urges that may cause bed wetting.
- Use of drugs or sprays: These drugs can be used to help the bladder work better at night.
- Waking: Involves waking the child to allow him/her to get up and urinate.
- Reward systems (e.g., star charts): The child might receive a star for every dry night, and a reward after a preset number of stars have been earned.
- Bladder-stretching exercises to increase functional bladder capacity have been used without consistent evidence of effectiveness.
- Retention control training: Attempting to increase the functional bladder capacity by delaying urination for extended periods of time during the day.
- Stop-start training: Teaching children to interrupt their stream of urine in order to strengthen their pelvic floor muscles.
- The impact of bedwetting can be reduced by using bed protection and washable/disposable products; using room deodorizers; thoroughly washing the child before dressing; and using emollients to prevent chafing.
- Make sure that there is adequate protection on bed sheet. This protection can be a waterproof cover.
- Make sure the bed is warm and comfortable.
- Try to use pull ups ( A type of nappy) on your child.
- Always keep a low-powered night bulb on.
- Encourage an adequate and regular fluid intake throughout the day.
- Avoid use of caffeine as it causes more urine to be produced.
Homeopathic Management of Nocturnal Enuresis
It is given to patient who lives in a world of his own world. He has spectres and visions and does not relate to surrounding realities. It cures various type of hallucinations in which he sees monsters, hideous faces. It cures delirium in which patient has frightful images, rages, bites, strikes and desire to escape. It is given when urine is dark and turbid. It is very good remedy for incontinence where there is no control on urination. Urination is freqeuent and profuse. Sometimes urine is scanty.
- Worse: Patient is worse from touch, noise, in after noon , from lying down.
- He feels better by semi:erect position.
Dosage: 30, 4 pellets every 4:6 hours per day for 15 days.
It is very important remedy for urinary complaints. Child has fear of going sleep. Child is confused, full and dislikes sympathy, it makes her angry. It is given when patient constant desire to pass urine at night. It is very good remedy for nocturnal enuresis. Child has difficulty in passing urine.
Dosage: Q 10:20 drops 2:3 times a day for 10 days.
It is given to patient who has indifference to those who loved him. They cannot do any work with interest. Child is irritable and easily offended. He dreads to be alone. He is very sad. It is very good remedy for nocturnal enuresis, during first sleep. It is very good remedy when patient has red urine.
- Patient is worse in forenoon and evening, from washing, laundry work, from dampness, after sweat.
- Patient is better by exercise, pressure, warmth of bed, by hot application, after sleep.
Dosage: 200, 4 pellets 2 times a day, 10 days.
It is good remedy when patient has difficulty in passing urine. It is given when patient has frequent urging with severe pain at the close of urination. Urine flows only drop by drop. It is very good remedy for incontinence in children with dreams or night mares when passing urine.
Dosage: Q 10 drops, mix in hot water , 2 times a day for 10 days.
It is given to patient who weeps easily. It is given to children like fuss and caresses. He is easily discouraged. Child is timid. He fears in the evening of being alone and ghosts. It is given when patient has increased desire which is worse when patient lies down. It cures involuntary urination at night while coughing or passing flatus.
- Patient is worse from heat, by eating fatty food, after eating, towards the evening, in warm room.
- Patient is better by motion, cold application, cold food.
Dosage: 200, 3-4 times a day for 15 days.