: Bed-wetting: An Overview of Nocturnal Enuresis
It's not unusual for children under the age of six to wet their
beds now and again, even after having been toilet trained for
a number of years. In fact, some children - boys especially -
will continue to have the occasional wet bed even beyond their
sixth year. It may surprise (not to mention relieve!) parents
to find out that this is not that unusual, and it doesn't necessarily
indicate a problem. But children who wet their beds more frequently
may have a common childhood condition called "nocturnal
What is nocturnal enuresis?
Nocturnal enuresis is defined as involuntary urination at night,
two or three times a week, in a 5 or 6 year old child - or at
least once a week in an older child. A child who has primary
nocturnal enuresis has never been dry at night for more than
6 months, whereas a child with secondary nocturnal enuresis
only began nighttime bed-wetting after a period of at least six
months of dry nights. Diurnal enuresis is defined as involuntary
daytime urination at an age when control should have been achieved,
usually by 3 or 4 years of age. Diurnal enuresis is considered
to be different in nature and cause from nighttime wetting, so
its treatment differs from that of nocturnal enuresis.
Bed-wetting is not a deliberate act or a sign of laziness.
It's important to stress that when children wet their beds, whether
they are enuretic or not, they should never be faulted, punished,
humiliated, or scolded. An angry or frustrated response from a
parent can damage the child's self-esteem, and even make the problem
Children who wet their beds frequently should have a comprehensive
medical examination by a doctor. A medical exam will help rule
out any other possible causes of the child's bed-wetting, determine
whether or not the child has enuresis, and identify the type of
enuresis. Based on this examination, the child's physician can
determine appropriate strategies for treatment.
Is nocturnal enuresis a serious health problem?
Nocturnal enuresis is generally considered a benign (non-health-threatening)
condition that usually resolves itself on its own, though it may
in some cases take years to disappear completely. However, while
enuresis may be superficially perceived as a minor problem, it
sometimes leads to serious psychological and social consequences
for the child when it's dealt with improperly. The child may suffer
embarrassment, guilt, loss of self-esteem, anxiety, alienation
within the family, and troubled social development if the condition
is not treated, or if the condition draws a negative response
from the family. It's therefore important that parents understand
their child's condition, and respond in a practical and effective
way with the guidance of a health care professional. Patience,
support, and a positive outlook are crucial aspects of successful
treatment. In fact, bed-wetting often resolves itself on its own
once the parents' and the child's anxiety is eased through an
improved understanding of nocturnal enuresis.
What causes nocturnal enuresis?
The exact causes of enuresis are not fully understood, although
there seems to be a number of contributing factors. Studies have
suggested that in some cases genetic inheritance seems
to play a role, with children of parents who had childhood nocturnal
enuresis having a significantly greater chance of developing the
condition than other children. In certain cases, psychological
factors such as stress may play a role in causing or aggravating
nocturnal enuresis. Other types of enuresis (such as daytime wetting,
or daytime wetting in combination with nighttime wetting) may
be caused by bladder dysfunction or instability. Nocturnal
enuresis has also sometimes been linked to constipation.
And recently, studies have suggested that in some enuretic children,
there is diminished secretion of antidiuretic hormones (ADH)
during the night, compared with children who stay dry throughout
the night. ADH is responsible for regulating and restricting urine
production in the body.
Is there a cure?
Though there is no single "cure" for enuresis, the good
news is that - given time - the condition will usually clear up
on its own. However, there are strategies which may help resolve
the problem sooner rather than later, and with fewer negative
consequences - though in any case parents have to exercise
patience and support.
Treatment strategies include motivational approaches such as a
reward system approach, in which the child receives positive
reinforcement (such as praise or extra privileges) in reward for
dry nights; behaviour modification approaches such as the enuresis
alarm system, which gradually conditions the child to anticipate
the need to urinate before actually wetting the bed; or medication
therapy, which can help control wetting in extreme or exceptional
cases. In cases where enuresis has been linked to constipation,
the problem of enuresis may be cleared up by simply treating the
Practical suggestions often given to parents include bedtime fluid
restriction, having the child urinate in the toilet before going
to sleep, waking the child in order to urinate prior to the parents
going to bed, and bladder exercises.
The various treatment strategies may be used alone, one after
another, or in combination, depending on the type of enuresis
diagnosed, and on each child's situation. Treatment strategies
should be monitored and followed up by a health care professional.
RELATED DR.PAUL LINKS:
Bedwetting: Do diapers
Bedwetting is common and
usually normal in pre-school age children
Medication may be helpful
in certain children that bed-wet
Other Childhood Illnesses
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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