Bed Wetting is known as Nocturnal enuresis in medical terms. It is a 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. The reason behind bedwetting is that a child’s bladder might be too small, or if 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 are more chances of bedwetting in a child who has at least one sibling, the parent, or an extended family member such as an aunt, uncle, or grandparent who also wet the bed after the age of 5.
True bedwetters do not wake after wetting. Bedwetting has nothing to do with dreaming. Wetting the bed is quite unconscious. A child has no memory that he has pass urine in bed.
Some children who wet the bed at night also have some trouble in the 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 the child has enuresis without lower urinary tract symptoms and without a history of bladder dysfunction.
- Non-symptomatic enuresis (NMNE) means the child has enuresis with lower urinary tract symptoms.
Enuresis can be classified as-
- Primary enuresis: when a child who is never been dry at night.
- Secondary enuresis: When a child has resumption of wetting after at least 6 months of dryness.
The 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. The majority of children have primary nocturnal enuresis. Those who have secondary enuresis may be due to the following reason-
- Stress in lifelike parental divorce, the birth of a 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 sleepers, but they did not wake before voiding. The arousal center 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 as delayed maturation of a normal developmental process. In children who have late in walking and talking can have problems with 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 fail 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: A 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 a low level of a hormone that controls how much urine is made. It is controlled by the brain.
- Sometimes bed-wetting is seen when the child sleeps in a strange place. They may be a bit worried when sleeping away from home.
Warning Signs Along with Bedwetting
- The child is ill or feverish.
- Urine dribbles day and night.
- Pain along with urination.
- The help of a doctor should be taken when the child reaches 5 and a half.
- If a 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
- A 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.
- The bladder training program is a good habit: In this training, the child learns to 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 bedwetting.
- 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 the bedsheet. 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 the use of caffeine as it causes more urine to be produced.
Homeopathic Management of Nocturnal Enuresis
It is given to a patient who lives in a world of his own world. He has specters and visions and does not relate to surrounding realities. It cures various types of hallucinations in which he sees monsters, hideous faces. It cures delirium in which the patient has frightful images, rages, bites, strikes, and desire to escape. It is given when urine is dark and turbid. It is a very good remedy for incontinence where there is no control on urination. Urination is frequent and profuse. Sometimes urine is scanty.
- Worse: Patient is worse from touch, noise, in the afternoon, 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 a very important remedy for urinary complaints. The child has fear of going asleep. A child is confused, full, and dislikes sympathy, it makes her angry. It is given when the patient constant desire to pass urine at night. It is a very good remedy for nocturnal enuresis. The child has difficulty in passing urine.
Dosage: Q 10:20 drops 2:3 times a day for 10 days.
It is given to a patient who has an indifference to those who loved him. They cannot do any work with interest. The child is irritable and easily offended. He dreads to be alone. He is very sad. It is a very good remedy for nocturnal enuresis, during first sleep. It is a very good remedy when a patient has red urine.
- The patient is worse in the forenoon and evening, from washing, laundry work, from dampness, after sweat.
- The patient is better by exercise, pressure, warmth of the bed, by hot application, after sleep.
Dosage: 200, 4 pellets 2 times a day, 10 days.
It is a good remedy when a patient has difficulty in passing urine. It is given when a patient has frequent urging with severe pain at the close of urination. Urine flows only drop by drop. It is a very good remedy for incontinence in children with dreams or nightmares when passing urine.
Dosage: Q 10 drops, mix in hot water, 2 times a day for 10 days.
It is given to patients who weeps easily. It is given to children like fuss and caresses. He is easily discouraged. The child is timid. He fears in the evening of being alone and ghosts. It is given when a patient has increased desire which is worse when the patient lies down. It cures involuntary urination at night while coughing or passing flatus.
- The patient is worse from heat, by eating fatty food, after eating, towards the evening, in a warm room.
- The patient is better by motion, cold application, cold food.
Dosage: 200, 3-4 times a day for 15 days.