Bed-wetting or nocturnal enuresis is a condition of passing urine in bed while sleeping. It is a common condition in infants and toddlers because bladder control is not developed at that age. Majority of children gradually acquire control over their bladder function.
But children who continue to pass urine even at an older age become a source of embarrassment, inconvenience and anxiety for the family. The child himself feels ashamed and loses his self-esteem. Some continue to have this problem even after becoming teenagers and adults. Apart from the embarrassment, bed-wetting can lead to infections.
Nocturnal enuresis can be primary, where it is persistent since childhood. In secondary cases, a child or adult previously dry develops enuresis later.
Genetic factors are also implicated in bed-wetting. It is said that if the parents were wetting their bed as children, the child has more than a 70 per cent chance of bed-wetting. Small size of the urinary bladder leads to bed wetting as the bladder cannot hold much urine.
In some individuals, deficient production of the anti diuretic hormone (ADH) causes bed-wetting. This hormone is responsible for reduced urine formation at night and when less in quantity, leads to abundant urine production at night resulting in bed-wetting.
Infections of the urinary bladder and urethra can lead to urinary incontinence and bed-wetting. Injuries, infections or tumors of the spinal cord or brain result in bed-wetting at any age due to damage to the nerve fibers 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 bed-wetting as the full bowel presses upon the urinary bladder.
People suffering from severe depression or psychological problems may wet their beds at night.
Whatever the cause for nocturnal enuresis, it is a very disturbing problem. 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 bladder control by the time he 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 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 2 hours prior to sleeping. This will ensure him 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 toilet. Gradually, the urinary bladder will be trained to function better. Thus the individual can wake up at that time on his 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 he remains dry and clean. The family should not make him feel ashamed. His morale and self-esteem should be kept high.
Though troublesome, bed-wetting is a problem which can be solved with patience, proper diagnosis and treatment.
Dr Rachna Pande is a specialist in internal medicine at Butaro Hospital