Nocturnal enuresis, or bedwetting, is a condition of passing urine in bed while asleep. It is common in infants and toddlers because bladder control is not developed at that age. The majority of children gradually acquire control over their bladder function as they grow. Sadly, some children remain unable to control their bladder well into adulthood, often resulting in embarrassment and discomfort. This can lead to lack of confidence and self-esteem. Apart from the embarrassment caused, bedwetting can lead to infections over and around the private parts, thighs and buttocks, like boils and fungal infections. Enuresis can either be primary, with the condition being persistent since early childhood, or secondary, where the onset of the condition occurs later in a previously dry child or adult. There is a strong genetic component to bedwetting, with research suggesting that a child has greater than a 70% probability of bed wetting if their parents had a history of it. Small size of the urinary bladder leads to bedwetting as the bladder cannot hold much urine. Deficient production of the anti diuretic hormone (ADH), causes bedwetting in some individuals. This hormone is responsible for reduced urine formation in the night and when less in quantity, leads to abundant urine formation in night resulting in bedwetting. Infections of the urinary bladder and urethra can lead to urinary incontinence and bedwetting. Injuries, infections or tumors of the spinal cord or brain result in bedwetting at any age, due to damage to the nerve fibres controlling the bladder. They also cause incontinence in the day time. Similarly, stroke causes 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 bedwetting as the full bowel presses upon the urinary bladder. People suffering from severe depression or pschyological problems may wet their beds. Whatever the cause for nocturnal enuresis, it is a very disturbing problem. The parents usually become restless and anxious if by three or four years of age if the child still passes urine in bed. But they should be patient. Some children develop good control over the bladder only by four or five years of age. Variations in age can occur when a child attains bladder control. In case of secondary enuresis, it is important to get the individual investigated to seek the cause of bedwetting. Treatment by either drugs or surgical intervention usually helps the individual to be rid of the problem. There are drugs available to treat primary enuresis. Restricted amount of fluids should be given to the individual suffering from enuresis in the evening. Ideally, no fluids should be given two hours prior to sleeping. This will ensure them to be dry for the night. Bladder training is very helpful in cases of nocturnal enuresis. A child or an adult with the problem should be woken up at a fixed time every night and taken to the bathroom. Gradually, the urinary bladder will be trained to void at that fixed time. Thus, the individual can wake up at that time on their own, pass urine, and avoiding bedwetting. Irrespective of the age of the person having enuresis, it is important for the caregivers to see that one remains dry and clean. The family should not make him one ashamed. Though troublesome, bedwetting is a problem which can be solved very well with patience, proper diagnosis and treatment. Dr Rachna Pande is a specialist in internal medicine.
