Bedwetting

What is Bed wetting ?

Bedwetting is defined as the involuntary passage of urine while asleep. Bedwetting is a very common urinary problem in children. Some children will continue bedwetting upto the age of 6 years. However subsequently, many of children are able to achieve good bladder control by the age of 15 years. About 15% children wet the bed at the age of 5 years but by the age of 15 only 1% of the children continue to wet the bed. The ideal age to see a urologist if the problem of bedwetting continues is above 5 years as there may be underlying urological issues that may cause subtle damage to the urinary system if not managed in time. In most patients the problem of bedwetting is more of a functional problem than a disease.

Here are some important questions that Dr. Raman will be interested to know about the condition:

1. How many times does the child wet the bed at night ?
2. How many nights in a week does the child wet the bed ?
3. Is there a particular time when this bedwetting occurs ?
4. What is the normal voiding pattern of the child ?
5. Are there associated bowel complaints as well ?
6. Are there any associated symptoms or abnormalities that the child may have ?
7. Is is primary or secondary nocturnal enuresis ?

What are the types of Bedwetting ?

Bedwetting or nocturnal enuresis is of two main types. Primary Nocturnal enuresis is a condition in which the child never achieves control over urine while in secondary nocturnal enuresis there is a period wherein the child does not wet the bed for at least six months and subsequently starts to wet the bed again. The two conditions are different and managed differently. Nocturnal Enuresis can occur due to problems at various levels.

1. Brain – Cerebral Palsy, Down’s Syndrome, Developmental Delay, Drugs, Stress, Sleep Apnea etc
2. Spinal Cord and Nerves – Neuropathy, Spina Bifida etc.
3. Bladder and Bladder Outlet – Neurogenic Bladder, Dyssynergia of the sphincter, Posterior Urethral Valves etc.

It is essential that the pathology be ruled out if any to prevent further damage to the urinary system. In most cases there is a functional disturbance which needs to be corrected.

What are the tests required for management of Bedwetting ?

The following steps can be taken for cure:

Investigations

• Urine Routine and Microscopy Examination: To rule out infections, renal damage, stones and other pathologies
• Urine Culture: To detect and manage infections
• Ultrasound of the Abdomen and Pelvis: To screen the urinary system and adjoining structures for any abnormalities, assess the bladder wall and post void residual urine
• Routine Blood Workup: Includes Hemogram, Kidney Function Tests and other special blood tests
• Uroflowmetry: Helps to assess the stream of urine and pattern of void
• Urodynamic Study: Can give a good idea about bladder pressures and overactivity
• Micturating Cystourethrogram: A dye is filled in the bladder and can help to delineate the bladder, assess its capacity, rule out reflux or posterior urethral obstruction and when combined with the retrograde urethrogram, it can help assess the entire urethra

How is Bedwetting Treated ?

Behavioral Therapies

• Wake up the child at night
• Reward the child for keeping dry
• Reward for Voiding before going to bed
• Improve access to toilet at night
• If child wakes up encourage voiding before going back to sleep
• Avoid fluids 3 to 4 hours prior to going to bed

Alarm Therapy for Bedwetting:

A bedwetting alarm is a great way to cure nocturnal enuresis. We have the resources at our disposal to procure and train you for using bedwetting alarms. These alarms sense the leakage of urine and help the child wakeup. It conditions the mind to subsequently wake up to pass urine when there is an urge. Vibration watches are also available that can act as reminders for children to go and pass urine

Medical Treatment for Bedwetting:

Drug therapy is also an effective way to manage nocturnal enuresis. Drugs can cause side effects like constipation and dry mouth and sometimes stopping the therapy prematurely can lead to recurrence of the symptoms. Steps of management include:

• Correct parental response
• Behavioural Modification
• Establish Cause
• Maintain normal voiding pattern

Is your child above 5 years and still bedwetting ? Consult best Urologist & andrologist of Gurgaon, Dr. Raman Tanwar. Book your appointment at +918383812737