Bedwetting (Nocturnal Enuresis)
Bedwetting is a common childhood condition that can occur even after your child has been toilet trained. In fact it is considered to be normal up to the age of 6 to 7 years. The odd episode that may occur thereafter but bedwetting that occurs in older children, teens or adults is not considered normal.
The medical term for bedwetting is nocturnal enuresis. Nocturnal refers to the nighttime and usually implies during sleep but can occur even if the child is napping in the day. Enuresis refers to involuntary urination. It largely overlaps with the medical term urinary incontinence which means the inability to hold back urine until the appropriate time to urinate, a condition that often affects the elderly.
The exact reason why bedwetting occurs in children is not always known. In teens and adults there is usually a medical condition contributing to it. Sometimes a person may be very deep in sleep, having consumed excessive alcohol or sedatives, and is unable restrain themselves. Urinary tract infections (UTIs) are another possible cause although adults with UTIs still have a relatively good degree of bladder control. However, nocturnal enuresis in teens and adults should be investigated by a doctor, or preferably by a medical specialist like a urologist.
In children, there appears to be many possible causes or contributing factors and the once-off episode is not necessarily a worry.
- Stress at home or school may bring about bedwetting for periods of time. Parents should be on the lookout for symptoms such as bedwetting to identify issues like bullying at school or abuse.
- A small bladder can be a problem especially when children drink large amounts of fluids before bedtime. Children may also be unable to recognise the signals of a full bladder or awake in time to reach the toilet.
- Hormonal problems like inadequate secretion of antidiuretic hormone (ADH) can also be a factor in childhood bedwetting. Sometimes these hormonal fluctuations are not a problem and will eventually resolve.
- Urinary tract infections (UTIs) are fairly common particularly in females and can be a cause of bedwetting. UTIs need to be treated medically as it can worsen into kidney infections if left untreated.
- Other possible causes includes:
- Constipation (long term)
- Diabetes mellitus
- Nerve conditions that affect bladder control
- Problems with the structure of the urinary tract
- Sleep apnoea
A soiled mattress, bed linen and sleepwear are seen with bedwetting. Sometimes the child is not aware of his/her mishap until the next morning, or may attempt to cover it up by removing the bed linen and hiding their pyjamas. It is therefore important parents to keep an eye on these telltale signs to record how often the child has been bedwetting. This information can help a doctor diagnose an underlying parents and assist parents in spotting potential psychosocial problems.
Although children are usually toilet trained by the age of 4 years, it is not uncommon for them to have the odd episode of bedwetting. It is only once bedwetting becomes a common occurrence after toilet training, or if it happens after the age of 7 years that parents should worry. However, even a single episode where the urine smells unusual, is stained pink or red, there is pain when urinating (while awake) or a child has other symptoms like nausea, vomiting, paleness, fatigue or confusion requires immediate medical attention.
The treatment for bedwetting varies depending on the cause. Sometimes patience is all that is needed as your child will gradually outgrow the problem. However, for older children who still have problem with bladder control and where there is no underlying disease, devices like a moisture alarm can be helpful. This device triggers an alarm when moisture is detect on the bed. It awakens the child to stop urinating and instead go to the toilet to empty their bladder.
Your doctor may prescribe drugs to:
- reduce the nerve impulses and muscle contractions in the bladder
- increases ADH secretion to reduce urine output at night
- alter the sleep-wake cycle and improve bladder control
An important part of managing bedwetting is to reassure the child that he/she will outgrow the problem or that the odd incident is nothing to worry about. Embarrassment and anxiety about wetting the bed can exacerbate the condition.
The choice of homeopathic remedy for treating bedwetting varies from one case to another. Remedies such as Cantharis, Pulsatilla and Staphysagria may be prescribed with some being indicated more for UTIs leading to nocturnal enuresis. Cinnamon and cranberry are said to be two effective herbal remedies for bedwetting but other specific herbs should be prescribed by a homeopath after a thorough case evaluation.