Managing enuresis ( bedwetting ) in children

The word enuresis (bedwetting in layman’s terminology) refers to passing of urine into bed clothes or inner garments.

As nearly 90% of such children pass urine at night during sleep the term bedwetting is commonly used to describe the condition.

The term primary nocturnal enuresis specifically refers to the condition of bed wetting during sleep in a child who has never attained bladder control.

Diurnal enuresis (day time wetting) is much less common. Another entity is secondary enuresis in which a child who had attained bladder control starts wetting his clothes again. Secondary enuresis is also uncommon and is usually due to psychological stress.

Primary nocturnal enuresis is usually due to maturational delay and is generally not due to any organic or psychological disease.

It should be remembered that normal child development varies widely and not all children attain bladder control at the same age. Often overenthusiastic parents make extraordinary efforts to ensure that their child is dry as early as possible so that they can proudly announce their achievement.

They may feel disappointed that their efforts are not productive. It is better to keep in mind that potty training is a gradual process.

Primary nocturnal enuresis is not diagnosed until the child is at least five years old. It is more common is boys than is girls. Daytime wetting occurs with equal frequency is boys and girls. It is common in children with attention defect hyperactivity disorder.

Secondary enuresis usually occurs following stressful events like birth of a sibling when the first child may not get enough parental attention, death in the family, or family conflicts.

The following conditions have to be rules out before diagnosing enuresis- urinary tract infection, urological abnormalities, neurological disorders and diabetes mellitus.

Management: It is very important not to overreact to this problem. Ridiculing and shaming the child should be avoided as this can cause low self esteem in the child. The child should be reassured that he/she will gradually stop bedwetting.

Fluid intake should be restricted after evening. Child should be encouraged to empty the bladder before going to bed. He/she should be encouraged to hold the urine for longer periods during day and made to stop the urine stream in the middle of micturition.

Some drugs are effective in treating bedwetting but relapse can occur. Imipramine-an antidepressant has been used with some success. The exact mechanism of action is not known. It can cause insomnia, mood changes and dry mouth.

Accidental overdose can even be fatal. The drug is given for 3 to 4 months and then gradually tapered. It should not be suddenly stopped. It can be used for short periods such as for attending camps.

Another drug is intranasal Desmopressin. Desmopressin helps by acting on the kidneys to reduce the amount of urine produced. The drug can cause headache, nausea and electrolyte imbalance. It is quite expensive and hence it is used after other measures have failed.

Bed wetting alarms have been used with variable results. The device which is attached to the child’s inner garments gives off an alarm as soon as it detects any moisture. The child is woken up and goes to the toilet.

Over a period of time the child learns to respond to the sensation of full bladder and wakes up to go to toilet before the alarm goes off. This is an example of behavioral conditioning.

Some herbal remedies have also been used for enuresis treatment with some success. But more studies are needed to establish the efficacy and safety.

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