Bedwetting in children

Enuresis is more commonly referred to as bedwetting. Nocturnal enuresis, or bedwetting at night, is the most common type of elimination disorder. Daytime wetting is called diurnal enuresis. Some children experience one or the other, or a combination.

This behavior may or may not be purposeful. The disease is diagnosed only if the child is 5 years old or older.

What are the symptoms of bedwetting?

The main symptoms of bedwetting include:

Repeated bed-wetting
Wetting in the clothes
Wetting at least twice a week for approximately three months

What causes bedwetting?

Many factors may be involved in the development of bedwetting. Involuntary or unintentional excretion of urine can be the result of:

A small bladder
Persistent urinary tract infections
Severe stress
Developmental delays that interfere with toilet training

Voluntary or intentional enuresis may be associated with other psychiatric disorders, including behavioral disorders or emotional disorders such as anxiety. Bedwetting is also hereditary, suggesting that a predisposition to this disorder may be hereditary. In addition, potty training that was forced or started when the child was too young may be a factor in the development of the disorder, although there are few studies to draw conclusions about the role of potty training, potty training, and the development of bedwetting.

Bedwetting children are often described as heavy sleepers who cannot wake up when they have to urinate or when their bladder is full.

How common is bedwetting?

Bedwetting is a common problem in children. It is estimated that 7% of 5-year-old boys and 3% of girls suffer from bedwetting. These figures drop to 3% of boys and 2% of girls by age 10. Most children outgrow the problem by the time they become teenagers, and only about 1% of men and less than 1% of women have the disorder by age 18.

How is bedwetting diagnosed?

First, the doctor will take a medical history and perform a physical examination to rule out any medical conditions that may be causing the passage of urine, called urinary incontinence. Laboratory tests may also be done, such as urinalysis and blood tests to measure blood sugar, hormones, and kidney function. Physical conditions that can lead to urinary incontinence include diabetes, infection, or a functional or structural defect that causes urinary tract blockage.

Bedwetting can also be associated with certain medications, which can cause confusion or behavioral changes as a side effect. If no physical cause is found, the doctor makes a diagnosis of bedwetting based on the child's current symptoms and behavior.

How is bedwetting treated?

Treatment may not be needed for mild cases of bedwetting, as most children with bedwetting outgrow it (usually by the time they become teenagers). It is difficult to say when to begin treatment, as it is impossible to predict the course of symptoms and when the child will simply outgrow the disease. Several factors should be considered when deciding whether to start treatment: whether enuresis affects the child's self-esteem and whether enuresis causes impairment in functioning, such as preventing the child from spending the night with friends.

When treatment is used, behavior modification therapy is most commonly recommended. Behavioral therapy is effective in more than 75% of patients and may include:

Alarms: Using an alarm system that sounds when the bed is wet can help your child learn to respond to nocturnal bladder sensations. Most studies on bedwetting support the use of urinary alarms as the most effective treatment. Urinary signals are currently the only treatment associated with sustained improvement. The recurrence rate is low, usually 5-10%, so once a child's urine composition improves, it almost always stays improved.
Bladder training: This method uses regular trips to the toilet at increasing intervals to help the child get used to "holding" urine for longer periods of time. It also helps increase the size of the bladder, which is a muscle that responds to exercise. Bladder training is commonly used as part of a bedwetting program.
Rewards: This may include a series of small rewards as the child achieves bladder control.

Medications are available to treat bedwetting, but they are usually only used if the disorder interferes with a child's functioning and are generally not recommended for children younger than 6 years of age.

Medicines may be used to reduce the amount of urine produced by the kidneys or to increase the capacity of the bladder. Commonly used medications include desmopressin acetate, which affects the excretion of urine by the kidneys, and imipramine (Tofranil), an antidepressant that also helps treat bedwetting.

While medications can help manage the symptoms of bedwetting, the child will usually start to urinate again when the medication is stopped. When choosing medicines for children, side effects and cost should be considered; Medications can help improve a child's functioning until behavioral therapies begin to work.

Most children with bedwetting outgrow the disease by the time they reach adolescence, with a spontaneous recovery rate of 12-15% per year. Only a small number, about 1%, continue to have problems into adulthood.

Can bedwetting be prevented?

It may not be possible to prevent all cases of bedwetting, especially those associated with problems with the child's anatomy, but seeing your child as soon as symptoms appear can help reduce problems associated with the condition. A positive and patient attitude towards the child during toilet training can help prevent the development of a negative attitude towards toilet use.