Q1. What is sleep enuresis (bed-wetting) in children?
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Q2. In whom does sleep enuresis occur?
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Q3. When is enuresis considered a disorder?
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Q4. How should this condition be handled? Do children with this condition have any major urinary problem? Is bed-wetting a
psychological problem?
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Q5. What causes sleep enuresis in children?
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Q6. How is sleep enuresis diagnosed?
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Q7. How is sleep enuresis in children treated?
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| Q1. |
What is sleep enuresis (bed-wetting) in children? |
| A1. |
The most common urological problem seen in children is bed-wetting during sleep (medically referred to as sleep enuresis or nocturnal enuresis). About 10-20% of 5 to 6-year-olds are known to wet their beds. It is estimated that there are around 80-110 million enuretic children in the world. |
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| Q2. |
In whom does sleep enuresis occur? |
| A2. |
Sleep enuresis is more common in first-born children. It is more common in boys than in girls. It is much more common if the parents have also had a similar problem or if there is a family history of the condition.
If one parent has had a similar problem, then there is a 44% chance of his or her child, or children, having a similar problem. If both parents have had this problem, then there is a 77% chance of their child, or children, having a similar problem. |
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| Q3. |
When is enuresis considered a disorder? top |
| A3. |
Enuresis is considered a disorder only if the child is at least 5 years of age and the problem continues more or less continuously for approximately one year.
It is primary enuresis if it has been present since birth and considered to be secondary enuresis if it starts between the ages of 5 and 8, that is, after the child has been toilet trained. |
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| Q4. |
How should this condition be handled? Do children with this condition have any major urinary problem? Is bed-wetting a psychological problem? |
| A4. |
Apart from the commonly faced problem of changing the sheets, this condition needs to be handled sympathetically because it affects the self-esteem of the child. A positive change occurs in children who are successfully treated. Therefore, treatment for sleep enuresis in the case of children is definitely worthwhile.
While bed-wetting can be caused by a variety of urological problems, it is very uncommon for a child with sleep enuresis to have any major urinary problem. In our general clinic, we find that only 1-4% of children with this problem have any urinary abnormality.
While bed-wetting can cause a psychological problem in children, all enuretic children are psychologically normal. A psychopathology is not a causal problem for primary enuresis, and therefore treatment for a psychopathology is ineffective in reducing bed-wetting. |
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| Q5. |
What causes sleep enuresis in children? |
| A5. |
There are numerous theories that have been put forth with respect to the causation of enuresis. It is generally considered a disorder of delayed maturation.
One contributory cause may be due to a deficiency of a hormone. This deficiency permits large urine volumes to be formed during the night, which the bladder cannot hold and therefore empties.
Some of these children are thought to have a respiratory block, either due to adenoids or tonsils, and therefore have enuresis. Removal of the tonsils has sometimes been found to lead to an improvement in their bed-wetting.
Foods that have been prepared using milk as an ingredient, drinks containing caffeine and a large fluid intake also contribute to bed-wetting.
Some allergies such as fever, eczema, rashes, food and drug allergies are also thought to contribute to this condition. |
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| Q6. |
How is sleep enuresis diagnosed? |
| A6. |
Since only a very small percentage of these children have an organic urinary abnormality, the evaluation of these children is very basic. This evaluation includes a physical examination, a urine microscopy and an ultrasound evaluation. |
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| Q7. |
How is sleep enuresis in children treated? top |
| A7. |
If all of the tests mentioned above are normal, treatment for this is pharmacological, psychological and behavioural. Quite often, success is achieved with a combination of all three.
The following are the recommendations for ensuring the most effective evaluation and treatment plan:
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The doctor should screen to rule out any possible urinary abnormalities. If something is found, a referral can be made to the urologist.
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All children should reduce their liquid intake to half the normal liquid intake from evening onwards.
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Most children should avoid caffeine.
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Children should get adequate sleep – the average 8-year-old should get about 10 hours of sleep each night.
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An alarm should be used to wake up the child so that he or she can pass urine at night. Due positive reinforcement should be provided to the child for dry nights. Parent should not punish children for this problem.
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To help them have a positive outlook, children may be made to change their bed linen when wet. Do not use diapers for children with this condition.
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A progress chart will be a good record for children with this condition.
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Children should urinate just before going to bed. On special occasions, such as overnight visits to relatives or friends, the drug DDAVP may be used. Depending upon the volume of urine that is passed overnight, the appropriate drug may be chosen, either to increase the bladder capacity or to decrease the urine output. |
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