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.
Sources:
www.Aafp.org
www.Parenting.com
www.Wikipedia.org
ww.Madeformums.com
www.parentsask.com
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722619
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