BENGALURU: Bed wetting or urinary incontinence is frequently reported in children. It means involuntary urination by the child, after an age, at which staying dry at night can be reasonably expected. It is seen in approximately 15 per cent of children at 5 years of age. Most of such children have isolated night-time symptoms. The prevalence of bed wetting decreases with age, occurring in only 1-2 per cent of children aged 14 years and older. While this is not a serious medical disorder, bed wetting can have far-reaching effects on both the child and on the family.
Causes
A small bladder: Your child’s bladder may not be developed enough to hold urine produced during the night
Inability to recognise a full bladder: If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
A hormone imbalance: During childhood, some kids don’t produce enough anti-diuretic hormone (ADH) to slow night time urine production.
Stress: Stressful events like starting a new school, or sleeping away from home or any family event such as conflicts between the parents or neglect by the parents.
Urinary tract infection: The infection can make it difficult for your child to control urination. Signs and symptoms may include bed wetting, daytime accidents, frequent urination, pain during urination, fever etc.
Deep Sleep: Sometimes the child is in deep sleep and does not recognise a full bladder
Chronic constipation: The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
Genetic tendency: Many children reported to have night time bed wetting have a family history in the form of a parent or elder sibling having gone through the same during their childhood. Most such cases resolve with increasing age.
Rare causes: Diabetes in children, chronic kidney disease, diseases related to spinal cord etc. are rarely seen as causes of bed wetting in children.
Signs and symptoms
Children learn to control daytime urination as they become aware of their bladder filling. However, it is important to consult a doctor if:
Your child is at least six years old (treatment for bedwetting is not recommended before this age as treatment is less effective and many children get better on their own)
You or your child are troubled or frustrated by the bedwetting
Your child wets or has bowel movements in their pants during the daytime.
Your child was “dry during night” for at least six months before being symptomatic.
Your child has symptoms suggestive of an underlying medical or surgical illness like weak urinary stream, difficulty in initiation of micturition or straining while passing urine, or intermittent dribbling of urine, associated weight loss / fatigue, chronic constipation etc.
Treatment
Let children know that many kids have the same problem
Do not punish or shame children for being wet at night
Make sure the child’s siblings do not tease him about wetting the bed
Encourage the child that before going to bed, the bladder should be emptied fully to help avoid wetting at night.
Encourage the child to wake up at night to urinate
Limit a child’s fluid intake in the evening. Avoid sugary drinks in the evening.
Motivational therapy: Make sure to give positive feedback to the child and make him/her realise the progress.
Alarm clocks: You may use simple alarm clocks to awaken the child 2-3 hours after sleep and encourage him to use the toilet.
The author is senior consultant, neonatologist and paediatrician, Cloudnine Group of Hospitals, Jayanagar