Bedwetting or nocturnal enuresis is involuntary passage of urine while the child is asleep at an age beyond which the sphincter control is normally developed. An occasional lapse by child should not cause concern. Bedwetting is of two types - Persistent (or primary) type and the Regressive type. In persistent type child has never been dry at night and in regressive type, the sphincter control is developed at normal age and child remains dry for several months after which child again starts wetting bed at night.
Prevalence of nocturnal enuresis at 5 yrs of age is 7% for males and 3% for females. At 10 yrs of age it is 3% for males and 2% for females and at 18 yr of age it is 1% for males and rarely present in females. There is a marked familial pattern.
Persistent Type
Persistent type of bed wetting is due to delay in maturation of neurological control of sphincters. Persistent type of nocturnal enuresis may also be due to inadequate or inappropriate toilet training. Parents who demand rapid toilet training may generate an angry response, the child unconsciously defy them by wetting the bed. But on the other hand parents who do not understand the timely need of toilet training may undermine childs effort to control the bladder.
One hypothesis also suggests that these children sleep deeply hence signal from distended bladder indicating the need to empty the bladder does not reach the conscious level of their brain during sleep.
Treatment for Persistent type of Nocturnal Enuresis
(a) Children should not be given liquids after dinner
(b) Child should void before going to sleep
(c) No punishment or humilation of child
(d) Reward therapy - Reward the child for being dry at night
(e) Conditional devices (alarm that rings when child wets the sheet) is reserved for persistent and refractory cases and is successful in more than 90% cases.
(f) Bladder stretching exercises
(g) Drug treatment is effective only briefly and there is exacerbation of symptoms once drug is discontinued.
Regressive type
This type of bedwetting is precipitated by stressful environmental events such as birth of a sibling, death in family, marital conflict and moving to a new home.
Treatment for Regressive type of Nocturnal Enuresis
This type of bedwetting is transitory. Prognosis is better and management is easier than persistent type.
In both types of bedwetting organic pathology is found only in small number of cases. Organic causes such, as anomalies of urinary tract, juvenile diabetes; nephropathies and neurologic illnesses should be excluded by physical examination and investigations.
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