Enuresis or bed wetting is the involuntary
passage of urine beyond the age of anticipated control that
is usually 5-6 years. 15-20% of children 5 years of age wet
their beds. Nearly 5% of 10 year olds will wet, and 1% of
adolescents and adults continue to wet. It is twice as
common in boys as in girls. Bedwetting also seems to run in
families.
What are the types of wetting
problems?
Primary enuresis means that the child has
been wet from the beginning, whereas secondary enuresis
means that the child had been dry earlier and has now
started wetting. The latter condition could be due to
urinary infection, diseases like diabetes, structural
abnormalities in the urinary passages or stressful
situations at school or at home like divorce, demanding
parents or the arrival of a sibling.
What are the symptoms?
Commonly, wetting at night is
the only symptom, but some children also have frequent
urination during the daytime with occasional wetting. It has
been seen that children who are constipated are more likely
to have enuresis.
What investigations are needed?
The doctor first takes a
detailed history and examines the child to exclude
structural abnormalities that may be the cause of
bed-wetting. In case a doubt persists after examination, the
doctor will order a urine test to exclude urinary infection.
An ultrasound scan may be done to evaluate the urinary
system for structural abnormalities. Rarely, special tests
may be asked for, like intravenous pyelography (IVP) that is
a special X-ray test after an injection into the vein, or
cystometry in which the pressures inside the urinary bladder
are measured.
What is the treatment?
The good thing is that a large number of
children stop wetting as they grow up. But during the time
that they are wetting, the social costs are enormous. These
children need all the support and compassion from their
parents and the care givers. Other methods that often help
include:
Behaviour modification techniques
such as rewarding the child for remaining dry
at night. The rewards may increase in value with each
passing dry night. It is inappropriate to punish the child
for a wet night. In fact, punishment worsens the situation.
Fluid intake should be limited from the
evening so that the child produces less urine. Sometimes
this regime may be harsh to enforce on children.
The use of alarm devices is beneficial.
These alarms use a pad inserted into the child's underwear,
so that as soon as the pad gets wet an alarm bell rings
waking the child up before the bladder empties completely.
This conditions the voiding mechanism in several children.
Unfortunately, good quality alarms are not available in
India.
Counselling of the child and the family
may be necessary in case an underlying emotional or
interpersonal problem is suspected.
In older children, and in those who fail to respond to the
above methods of treatment, medicines may be prescribed.
Imipramine is a commonly used drug that is normally
prescribed for the treatment of depression in adults. It
helps correct bedwetting in about 30% of children and needs
to be given for 4-6 months. The side effects of
imipramine include sleepiness and mood changes. Another
medicine called desmopressin, that is a derivative of
the hormone vasopressin also helps in about 30%
cases. This drug is given as a spray into the nose. This
latter drug is expensive.
Most successful treatment programmes require a multifaceted
approach. Often a combination of techniques gives better
results. In case of relapse after stopping treatment, the
regimen may need to be started all over again. Success in
treatment depends on a motivated child and dedicated and
compassionate parents.
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