Health: Bed wetting or Nocturnal Enuerisis

Bed wetting or nocturnal enuresis is a condition of passing urine in bed while sleeping. It is fairly common in infants and toddlers because at that age one does not have control over urinary bladder. But after that age, majority of children acquire good control over their bladder function. When they have the need to urinate, they can call some family member and go to the toilette. Thus they keep dry while sleeping. But children who continue to pass urine even at an older age, become a source for embarrassment, inconvenience and anxiety for the family. The anxiety and embarrassment becomes more if the child has to stay overnight with friends or relatives, worse still if put in a boarding school. The child himself loses self esteem and lives in fear of being mocked by peers. Some continue to have this problem even after becoming teenagers and adults. Apart from the embarrassment caused, bed wetting can lead to infections. It also involves increased labour and expenditure in the family in terms of increased washing and use of diapers. Nocturnal enuresis can be primary, where it is present persistently since childhood. Secondary type is the one, where a child or adult previously without the problem develops enuresis. Genetic factors are involved in bed wetting. It is said that if the parents were wetting their bed as children, the child has more than70% chance of bed wetting. Small size of the urinary bladder also leads to bed wetting as the bladder cannot hold much urine. In some children and even adults, deficient production of the anti diuretic hormone (ADH), causes bed wetting. This hormone is responsible for reduced urine formation in the night and when less in quantity, leads to much urine formation during the night resulting in wetting the bed. Infections of the urinary bladder can cause enuresis. Urethral infections can also lead to incontinence of urine and bed wetting. Injuries, infections or tumours of the spinal cord or brain may result in bed wetting at any age, due to damage to the centre or nerve fibres controlling the bladder. They also cause incontinence in the day time. Similarly strokes cause damage to the bladder control centre resulting in nocturnal enuresis. Advanced cases of prolapse of the uterus in middle aged or elderly women can lead to enuresis. Some cases of chronic severe constipation can result in bed wetting as the full bowel presses upon the urinary bladder. People suffering from severe depression or psychological problems may wet their beds in the night. Whatever the cause for nocturnal enuresis, it is a very disturbing problem more so in a growing child or adult. In case of a toddler, there is nothing to worry about. The parents usually become restless and anxious if by 3 or 4 years of age, the child still passes urine in bed. But they should be patient. Usually a child develops good control over the bladder by the time it is 4 or 5 years. But variations in age can occur. In case of secondary enuresis, it is important to get the individual tested to seek the cause of bed wetting. Treatment by either drugs or surgical intervention usually helps the individual to be rid of the problem. There are drugs to treat primary enuresis as well. Restricted amount of fluids should be given to the individual in the evening. Ideally he or she should be given early dinner and no fluids 2 hours prior to sleeping. This will ensure the person to be dry for the night. Bladder training is usually very helpful in cases of nocturnal enuresis. A child or adult with the problem should be woken up at a fixed time every night and taken to the toilet. Gradually, the urinary bladder will be trained to void urination at that fixed time. Thus the individual can wake up at that time on their own, pass urine in the toilet, thus avoiding bed wetting. Irrespective of the age of the person having enuresis, it is important for the care givers to see that the bed wetter remains dry and clean. The family should not make child feel ashamed but help in keeping its esteem and morale high. Though troublesome, bed wetting is a problem which can be properly solved with patience, proper diagnosis and treatment. rachna212002@yahoo.co.uk