Bed-Wetting

Introduction
Bed-wetting (also known as nocturnal enuresis) refers to unintentional passage of urine during sleep. Enuresis is a medical term used for wetting in clothes during daytime or in bed at night. Alternative name for enuresis is urinary incontinence.

In infants and young children, urination is not voluntary and hence wetting is normal. By the time children reach 4 years of age, they gain bladder control. Initially, daytime control is achieved followed by urination control during night. The age at which bladder control is expected varies considerably.

Bed-wetting is more common in boys. Child’s overall physical and emotional health is important as chronic illness or emotional abuse can expose kid to bed-wetting. It is a very common problem. A child with bed-wetting problem needs parental support and reassurance.

It can be treated with medications and remedies.

Symptoms
Bed-wetting is a condition comprising of involuntary urination during night. Though kids are trained to use toilet, some of them are unable to develop full bladder control. Those between 5 and 7 years of age are seen to have this problem.

Causes
Various factors could be responsible for bed-wetting process.

  • Bladder size: a smaller bladder is unable to hold urine during the night. When bladder controlling nerves do not mature, a child may not realize the time for him to empty his bladder.
  • Hormonal imbalance: some children are unable to produce required anti-diuretic hormone (ADH) that slows nighttime urine production.
  • Stress can also trigger bed-wetting.
  • Urinary tract infection can also cause bed-wetting, frequent urination, or painful urination.
  • Diabetes: Bed-wetting is sometimes considered to be the initial sign of diabetes. Other symptoms include passing large amounts of urine, increased thirst, fatigue and weight loss despite of a good appetite.

Bed-wetting could also be due to constipation. Any structural deformity in bladder or nerves could also be responsible for bed-wetting.

Diagnosis
The doctor will conduct a physical exam. Following tests may be recommended to find underlying causes.

  • Urine tests to ascertain presence of an infection or diabetes
  • X-rays or other imaging tests of the kidneys or bladder are done to check structural abnormality of child’s bladder or know any other problem that may be present.

Treatment
Doctor may prescribe certain medications to treat bed-wetting problem in a child. Drugs that boost hormone levels or calm the bladder are recommended.

Drug desmopressin enhances levels of a natural anti-diuretic hormone also known as ADH, which forces the body to produce less urine during night time. It is advised to drink less fluid with this medicine as low levels of sodium can likely cause seizures. The drug can produce side effect such as headache and nausea. However, this medication is helpful mostly for short duration camps.

When the child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) can help lessen bladder contractions and increase bladder capacity. It is usually administered with other medicines as a sure shot measure to cure bed-wetting.

Home Remedies
Cinnamon is given in form of powder with sugar to cure bed-wetting. Consumption of Indian gooseberry pulp; walnuts; and raisins are helpful.

It is helpful to develop regular toilet habit in child. Beverages that contain caffeine should be avoided. Treating constipation is very useful.

Homeopathic Remedies

Equisetum: It is a common remedy for nocturnal enuresis and is used when child wets the bed during dreams or nightmares. It also treats other forms of urinary incontinence.

Argentum Nitricum: It is also known as Silver Nitrate and Arg Nit. It is a popular homeopathic remedy for anxiety when administered in form of diluted solutions. It is useful for an anxious child with bed-wetting problem.

Sulfur; Causticum  or Potassium hydrate; and Sepia are other remedies used to treat bed-wetting problems and also for strengthening the kidneys.

Consult a homeopath to get suitable remedy, depending on the symptoms.


References
1. Foreman JW (2011). Kidney or urinary tract disorders. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 1691–1696. New York: McGraw-Hill.

2. Graham KM, Levy JB (2009). Enuresis. Pediatrics in Review, 30(5): 165–173.

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