Urinary incontinence (enuresis) is the medical term for bedwetting.
Bedwetting is often found in young children but is less common as they grow older. Most children respond well to treatment, although they can still wet the bed from time to time.
WHAT IS BEDWETTING?
Bedwetting is defined as intermittent urinary incontinence during sleep in a child at least five years of age. Approximately 5% to 10% of all seven-year-olds have enuresis, and an estimated 5 to 7 million children in the United States have enuresis.
The pathophysiology of primary nocturnal enuresis involves the inability to awaken from sleep in response to a full bladder, coupled with excessive nighttime urine production or a decreased functional capacity of the bladder. The initial evaluation should include a history, physical examination, and urinalysis. Several conditions, such as constipation, obstructive sleep apnea, diabetes mellitus, diabetes insipidus, chronic kidney disease, and psychiatric disorders, are associated with enuresis.
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When is bedwetting a problem?
Many children have bedwetting from time to time. Some may take longer to learn to control their bladder. Girls normally control the bladder earlier than boys. For this reason, bedwetting is diagnosed earlier in girls and can be detected as early as age five. Children are not diagnosed until they are at least six years old.
Types of enuresis
Doctors divide bedwetting into four classes. A child can have one or more of these types:
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Daytime wetting. The child gets wet during the day.
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Nocturnal enuresis. The child gets wet at night. Generally it is spoken of that it pisses in the bed. It is the most common type of enuresis.
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Primary enuresis. It occurs when the child has not fully learned to go to the bathroom.
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Secondary enuresis. It occurs when the child had a period without getting wet, but then had incontinence periods again.
Causes of Bedwetting
Bedwetting cannot be considered as a child's neglect, and often there is no obvious explanation for why this is happening. In many cases, bedwetting is familial.
Most often, the problem arises because the child:
- produces more urine than his bladder can handle ;
- has an overactive bladder, that is, it can hold only a small amount of urine;
- He sleeps very deeply, so he does not respond to a signal telling the brain that the bladder is full .
There may be several reasons at the same time.
Drinking before bedtime
Drinking plenty of fluids in the evening can cause the baby to urinate at night, especially if he has a small bladder. Drinks containing caffeine, such as cola, tea, and coffee, can also increase urination.
Inability to wake up at night
Once the amount of urine in the bladder reaches a certain point, most people wake up because they feel the need to go to the toilet. But some young children sleep very soundly, and their brain does not respond to the signals sent by the bladder, so they do not wake up. In some children, the nerves responsible for the bladder are not yet fully developed, so they do not send a sufficiently strong signal to the brain.
Sometimes a child wakes up at night because of a full bladder, but does not go to the toilet because of children's fears, in particular, fear of the dark.
Health status
Bedwetting can also be caused by a disease:
- constipation - when a child’s intestines become clogged with solid feces, he puts pressure on the bladder and this can lead to nighttime urinary incontinence;
- infectious inflammation of the urinary tract (UTI) - in this case, other symptoms can be observed, including pain during urination and fever;
- type 1 diabetes mellitus - other common symptoms of this disease include fatigue and a constant feeling of thirst.
Emotional problems
Bedwetting may indicate a baby is worried or upset. Going to a new school, bullying, or having a new child in the family can be a very stressful situation for a small child.
If a child begins to urinate in bed after he has remained dry at night for some time, the cause may be an emotional problem.
How is enuresis diagnosed?
Your child's healthcare provider will ask about the child's medical history. Be sure to tell your healthcare provider:
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If other family members have bedwetting
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How often does your child urinate during the day
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How much does your child drink at night?
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If your child has symptoms such as pain or burning when urinating
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If the urine is dark or cloudy or has blood
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If your child is constipated
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If your child recently had a stressful situation
Your child's health care provider may do a physical exam. In addition, the child may need tests, for example, urine or blood tests. These tests are done to detect health problems, such as diabetes or an infection.
Tips for controlling bedwetting
- Make sure that the toilet is easily accessible to the child at night. For example, if the bed is bunk, a bed-wetting child should sleep in the lower bunk. You can also leave light for him in the toilet and put the child seat on the toilet.
- Use waterproof covers on your baby's mattress and duvet.
- Try not to wake the child at night and do not carry him to the toilet, as this is unlikely to help him in the long run.
- Make sure your child has clean bedding and comfortable nightwear.
If after all of the above, it is still difficult for the child to cope with bedwetting, you should talk with your doctor.
Treatment
'Most children stop urinating in bed as they grow older, but if you want to speed up this process, you can try a number of measures'.
- Self-care for bedwetting
The following measures can help prevent urinary incontinence:
1. Offer drinks frequently throughout the day
Make sure your child drinks enough during the day. It is best to avoid drinks one hour before bedtime. Avoid drinks that contain caffeine, such as cola, tea, coffee, or hot chocolate, because they increase the need for urination.
2. Encourage regular toilet breaks
Encourage your child to use the toilet regularly throughout the day. Make sure the baby urinates before bed and that he can easily use the toilet at night.
3. Try a reward scheme
Bedwetting is not something that a child can control, so the reward should not be based on whether he wet the bed or not. Instead, you can give rewards for things like this:
- drink during the day;
- Do not forget to urinate before bedtime.
If the reward scheme does not work after about a week, it is better to abandon this method and try something else.
It is important not to punish the child and not deny him care and affection if he wet the bed, as this will put him under more stress, which will increase nighttime urinary incontinence, and not reduce it.
Enuresis alarm
If self-help measures do not help, the next step will be to use a special alarm clock. An alarm is emitted by a sensor attached to an alarm clock. When the sensor gets wet, it turns on the alarm and it wakes the baby.
For children with hearing impairment, you can use a vibration alarm.
Where can I get an enuresis alarm?
Enuresis alarms are usually not available at the National Health Service, but can be rented at your local enuresis clinic. The family doctor can tell you more about this. In addition, an enuresis alarm can be bought.
How does an alarm clock work?
Over time, the alarm clock should help the child find out when he needs to wake up to go to the toilet. This can help reward your child for getting up when the alarm sounded and remembering how to turn it off.
An enuresis alarm should usually be used for at least four weeks. If there is no sign of improvement after four weeks, talk with your doctor.
Using an enuresis alarm is not suitable for all children - for example, this is problematic if the child lives in the same room with his sibling.
Medication for bedwetting
If a warning about urinary incontinence does not help or does not fit, medication is usually recommended.
Your doctor may suggest a medicine called desmopressin. It helps reduce the amount of urine produced by the kidneys. It is taken just before the child goes to bed. If desmopressin or an enuresis alarm (or a combination thereof) does not help, the child may be referred to a specialist who might recommend other medicines.
Measures against bedwetting, which can be enjoyed in the house conditions
It is best to try a few measures first:
- Do not give your child anything to drink an hour before bedtime .
- Do worry that he urinated before bedtime .
You can also consider the advisability of buying an alarm clock.
Reassure your child. It is important for children to know that they have not done anything wrong, it will only benefit. Do not scold or punish them for wetting the bed; this will not help, but can only aggravate the problem.
Measures against bedwetting from a general practitioner
Your doctor may recommend using an enuresis alarm. These are moisture-sensitive pads that the child puts on his nightwear. If they start to get wet, an alarm sounds.
You can borrow such an alarm clock at a local clinic specializing in the treatment of urinary incontinence or enuresis.
If the use of the alarm does not work or does not work, medicines for bedwetting can help. Drug therapy is usually not prescribed for children under the age of five.
When to see a doctor
Bedwetting becomes a real problem when it starts to bother you or your baby. In children under five, this is usually not considered a problem.
It is worth talking about this with your doctor if:
- A child has other symptoms besides bedwetting, such as pain during urination, fever, or constipation .
- The child suddenly began to wet the bed again after he had not done this for some time.
Often, for the first time, a family seeks medical help when bedwetting begins to affect the child’s social life — for example, the child does not want to stay overnight outside the home because the bed can wet.
NATURAL TREATMENT FOR ENURESIS
- Sleeping with a bag containing these two plants attached to the skin was an ancient remedy to prevent nighttime bedwetting in children.
- Chop 1 fresh garlic, 2 tablespoons of fennel seeds and 1 tablespoon of thyme, then mix.
Once the shamrock is prepared, the bag is placed inside the pajamas hooking it through a small safety pin. The bag always had to remain in contact with the child's skin.
This remedy used to be used for a month, changing the garlic every 3 days. And when the child had stopped peeing, the bag was gradually removed, first, every other day, then every other day, and so on until it was completely removed.
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