Nocturnal enuresis, commonly called bedwetting, is unintentional passing of urine while asleep after the age at which bladder control usually occurs. Bed wetting of children may be simply a delay in the establishment of voluntary control over the act of micturition
It is the most common childhood urologic complaint and one of the most common pediatric-health problems. Most bedwetting, however, is just a developmental delay. It is not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.

Why are you not wetting your bed at night?

There are two physiological functions that prevent bed wetting at night. First one is an antidiuretic hormone called arginine vasopressin which reduces urine production at night. Second one is the ability to wake up when the bladder is full. The first one will not be there at birth. Many children develop it between the ages of two and six years old, others between six and the end of puberty.
The typical development process begins with one- and two-year-old children developing larger bladders and beginning to sense bladder fullness. Two- and three-year-old children begin to stay dry during the day. Four- and five-year-olds develop an adult pattern of urinary control and begin to stay dry at night.

What cause Bed wetting?

There are many reasons for Bed wetting. Some of them are as follows.

·         Neurological-developmental delay: - Most bedwetting children are simply delayed in developing the ability to stay dry and have no other developmental issues.
·         Genetics: - Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.
·         ADHD(Attention deficit hyperactivity disorder)
·         Caffeine:- it can increase urine production
·         Alcohol conception
·         Physical abnormalities:- Less than 10% of enuretics have urinary tract abnormalities, such as a smaller than normal bladder.
·         Infection/disease:- these are more strongly connected with secondary nocturnal enuresis and with daytime wetting.
·         Stress:- It is not a cause for primary NE. It is mostly associated with Secondary NE
·         Traumatic: -    After circumcision operation or Catheterization. It comes in Secondary NE
·         Worms can a reason for NE
·         Bad toilet training, some bad home situations and problems at school can cause NE.
·         Some Doctors believe that it is a kind of habit. It’s been found a sudden stopping of NE after marriage in girls as they are cautious and conscious about it.

Symptoms and signs associated with NE.

   §  Frequency of urination
   §  Urgency
   §  Burning on urination
   §  Discolored urine
   §  Unable to control defecation
   §  Constipation
        The main symptom will be wetting of bed at night even after age of bladder control.
        The above symptoms are mostly seen In secondary NE.

How to diagnose the situation?

  A careful history should be obtained and a thorough physical examination should be performed to look for causes of Nocturnal enuresis in children who present with bed-wetting. Causes of complicated enuresis include urinary tract infection, spinal cord abnormalities with associated neurogenic bladder, posterior urethral valves in boys, and ectopic ureter in girls. In addition, a bowel history is needed to rule out chronic constipation.
Parents should be questioned about their family history and the child's medical history . Careful questioning of parents and children can be extremely helpful in determining the type of enuresis and a possible cause or contributing factors.

What should Parents do?

Parents often are not fully aware of their child's daily voiding habits. Thus, a voiding diary may need to be maintained for a week or more. The family should keep track of how many times the child voids during the day and how many nights the child wets the bed. Do not punish your kid for wetting your bed.
Reward or appreciate your kid when you get a dry night in between.

Follow the things given below and feel happy with your kid.
  • Limit drinks after dinner, and keep caffeinated beverages to a minimum all day (they irritate the bladder and make the kidneys produce more liquid).
  • Start the habit of using the bathroom right before bed.
  • Explain that it's okay to get up during the night to go to the bathroom. (And leave a nightlight on in there.)
  • Consider stationing a portable potty (and a nightlight) in your child's bedroom.
  • Don't wake your child to use the potty before you turn in  -- it won't teach him to get up on his own.
  • Never push him, shame him, or make him sleep in a soggy bed. It could have the opposite effect, causing daytime accidents and lowering self-esteem.
  • Offer simple gift -- a sticker, say, and words of praise -- when there's a dry night.
  • Expect accidents. Retire the diapers once your child's able to stay dry five nights in a row (it's fine to bring them back out if his streak doesn't last), but don't take the plastic cover off the mattress for another year or so.
Behavioural therapy
Simple behavioural therapy (such as reward systems or waking a child to void in the toilet [‘lifting’]) may be effective for some . Punishment and humiliation are to be avoided .Dry bed training, as described by Azrin and Thienes , is a more labour-intensive parent-awakening technique and may be slightly more effective in combination with alarm therapy than alarm therapy alone.
Studies examining simple behavioural therapies are too disparate in methodology to be analyzed using meta-analysis . Individual small trials cite fewer wet nights with reward systems (eg, ‘star charts’) and lifting. The potential for negative consequences of such therapy has not been carefully studied.
It may be difficult to convince a child that a wet night is nothing to be ashamed of when dry nights are rewarded. The failure to achieve dry nights leading to stars or stickers may contribute to poor self-esteem. Lifting is labour intensive and may contribute to frustration and conflict. The goal of treatment is largely to reduce problems with frustration, conflict and poor self-esteem and, thus, behavioural therapies for enuresis may do more harm than good.


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