Enuresis or involuntary bed wetting is a common problem in childhood. About 15% 0f 5 year olds are affected and the problem remains in about 3% of 15 year olds. It may occur at night or during the day. These children usually have a positive family background of enuresis. Main reason noted is due to delayed maturation of bladder.
Primary or secondary?
Night time wetting can be divided into 2 parts, either primary or secondary. In primary cases, complete dryness never been fully achieved by the child. In secondary cases, the child manage to achieve dryness however the problem regresses or relapse, sometimes due to stress or any life changes in the child. Other definition of secondary enuresis is wetness after >6 months dryness.
My child is bed wetting, is there anything I can do???
First of all, we have to understand the nature of bed wetting. Again, it is due to delay maturation of bladder. Night time bed wetting is regularly seen in child age group 1 to 10 year olds. 1/6 children will spontaneously improve without any treatment. Remember to properly toilet training your child. Patience and encouragement will be a big help. For the younger ones, we can try lifting the child. Restricting fluid after dinner is another approach. Reward for every dry night achieve may interest the child. Star chart system may attract the child too. Any kind of punishments are definitely not recommended and it may worsen the problem. Wearing nappies during night time also is known to be a bad choice for parents to use on their child.
If the symptom progress, you should take your child to see the doctor. They can examine your child and possibly the urine test. Not rare that urinary infections in child lead to involuntary bed wetting. Occasionally, diabetes or genitourinary abnormality may be revealed.
Any other alternatives doctor?
As an alternative, a buzzer alarm is successful in treating night time bed wetting. This kind of technique should be tried up to 8 week period. Success may be seen as early as 3 weeks and high relapse may be reduced by continuing training afterwards. However, it not suitable for all, only for older child age more than 7 years.
An additional alternative, medications can be used if necessary. Desmopressin and imipramine are known drug to handle this problem. These medications can be given via spray or tablet. However, they shouldn’t be use for a long period because they have their own side effects. They will be most useful in the short term for example when the child stay a night over at friend’s house or even going for a trip. On the other hand, the symptoms more often than not relapse once the medication is stopped. Oxybutinin at night may help if bladder irritability diagnosed.
In secondary night wetter, we should consider any psychological stress that may be lies behind the relapse. So, do take your child to see your general practitioner, he/she will take a full history and who knows he/she can find any factors that may have caused this relapse. The most important part is the GP can do something for your child rather than see the symptom deteriorate.
My child is a day light wetter…
In comparison with boys, girls are more common to get day time wetting. This is due to so-called ‘holding on’ behavior which normally seen in girls. The affected child usually been too busy to sit long enough on the toilet bowl to finish their business (to empty the bladder). Incomplete emptiness of bladder might lead to urinary tract infection. What you can do is to give more fluid for your child. Perhaps, you can double the fluid intake. Routine of going to the toilet will help the girls (or boys) to train their toilet behavior. Should any infection suspected, your GP will prescribe your child with appropriate antibiotics.
Summary
Bed wetting is common and patience is the key. Other kind of alternative medications may help but positive encouragement is the mainstay of treatment. Your child will eventually outgrow this (most of the time). You just have to make sure that it is not pathological or psychological. Don’t forget to see your GP if symptom regressing and your children get older but the symptom not improve. Should any infection occur, antibiotic is the answer.
Reference:
- Oxford handbook of clinical specialties, 5th edition
- Enuresis: Child health fact sheet. Children Hospital, Ireland.
