Bedwetting in Children: Why does it happen and what to do?

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Bedwetting or bedwetting occurs when a child has bedwetting at night without knowing it. Most children, stop bedwetting between the ages of 5 and 8. Bedwetting is more common in boys and in deep sleepers.

This is not a serious health problem and children usually grow faster. However, bedwetting can be frustrating for children and parents. So why does bedwetting happen and what to do? In this article, we will provide useful information for parents to understand the causes and how to handle when children often wet the bed at night.

1. What is nocturnal enuresis?

Nocturnal enuresis is a condition in which a child is unable to urinate or urinate during sleep. It is a developmental delay and not an emotional problem or any physical illness. 5% to 10% of bedwetting cases are due to specific medical causes. A few cases are related to family history.
In most cases, it goes away on its own without treatment as the child gets older. Bedwetting is very common, especially in children under 6 years of age. By the age of 5, bedwetting occurs in about 15 to 20% of children. As age increases, the incidence of bedwetting decreases: 5% at 10 years, 2% at 15 years, and less than 1% in adults.

2. Children who are prone to bedwetting

Children with a family history of nocturnal enuresis. Neurodevelopmental retardation in children reduces the ability to recognize a full bladder in children. Boys are more susceptible to nocturnal enuresis than girls. Some children may urinate accidentally while awake. This is related to some physical problems. Children are under psychological and physical stress. Children live in disorganized homes. A very small percentage of children (2%-3%), have medical problems such as urinary tract infections, diabetes, kidney failure, pinworms, constipation, a small bladder, abnormalities in the spinal cord, or urethral valve defect in boys.

3. Types of nocturnal enuresis

3.1 Primary enuresis (PNE)

This is the most common bedwetting, has been around since childhood and continues to this day. It recurs continuously and significantly affects children's activities. Primary bedwetting can occur during the day for one child or at night for another. This is a developmental delay that can go away over time. Diet can affect bedwetting in children.

3.2. Secondary bed-wetting (SNE)

Is the phenomenon of urinary incontinence in a child who has never had bedwetting before. This may be due to the child having a urinary tract infection, stress, or poor health due to illness.

4. What causes children to wet the bed at night?

4.1. Primary bedwetting

Children's bodies are developing (bladder, nervous system, brain are not fully developed) / Children have bladder problems such as small bladder not enough to hold the amount of urine excreted during the night. Children with hormone imbalances: During childhood, some children do not produce enough anti-diuretic hormone (ADH) to slow urine production at night. Your child may not be able to control urine output throughout the night, may not wake up with a full bladder due to slow maturation of the nerves that control the bladder, a full bladder may not wake your child - especially if your child is a deep sleeper. Children have a habit of holding urine and do not want to go to the toilet, delaying going to the toilet for a long time. Increased urine production due to caffeine or diuretic use. Chronic constipation: Smooth and circular muscles are used to control urine and pass stools. With chronic constipation, these muscles can become dysfunctional and contribute to nocturnal enuresis.

4.2. Secondary bedwetting

When the child wetting the bed again after at least 12 months without recurrence. The incidence tends to increase as children get older. Causes:
Urinary tract infection: causing irritation that makes the child always want to urinate and urinate often, urine is red or pink and painful when urinating. Infection can also be due to some anatomical abnormalities. Diabetes: For a child who has never had bedwetting at night, suddenly wetting the bed frequently could be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue, and weight loss despite feeling good. Anatomical Abnormalities: These can be abnormalities in organs, muscles or nerves or any other urinary problem. Sleep Apnea: Sometimes bed wetness is a sign of obstructive sleep apnea, a condition in which a child's breathing is interrupted during sleep - often due to inflamed or enlarged tonsils or adenomas. Other signs and symptoms may include snoring and daytime sleepiness. A nerve problem: If the nervous system is defective, injury, or diseased, it can cause a nerve imbalance that affects urination. Social or psychological stress: Stress in family life due to conflicts between parents can cause a child to wet the bed. Lifestyle changes, like starting school or moving can be a cause of bed wetting. Children who are physically or sexually abused can also experience bedwetting.

5. Diagnosis of nocturnal enuresis

Take your child to the doctor if his or her nocturnal enuresis persists. To accurately diagnose nocturnal enuresis, doctors take the following steps:
Ask about the child's family history, genetics, and medical history. This will help determine the type of bedwetting and possible causes of the bedwetting. Causes of bedwetting can include abnormalities of the spinal cord (involving the nerve center that controls the bladder, urinary tract infections and posterior urethral valves in boys and ectopic ureters in children). sister). In addition, children suffer from chronic constipation and urinary incontinence. General health examination for children. Urinalysis to check for signs of infection or diabetes X-rays or other imaging tests of the kidneys or bladder to see the structure of the urinary tract. Other tests or evaluation of the urinary tract, if needed.

6. Treatment of nocturnal enuresis in children

Almost 90% of children around 7 years old stop bedwetting, most doctors will not recommend treatment for children under 7 years old. The reason is that bladder control during sleep is the final stage of potty training.
Doctors will likely recommend different measures for the initial treatment of bedwetting including education, motivational therapy, and changes in water and toilet habits. If bedwetting doesn't improve with these measures, your doctor may recommend that you try alarms or medication for bedwetting.

6.1. Education and motivational therapy

Children must be thoroughly educated about bedwetting. Bedwetting is not the fault of the child, so do not blame or admonish your child for bedwetting. Be careful not to make fun of your child for bedwetting. It is important to reduce the stress the child experiences from bedwetting. The child's family should encourage the child and the child needs to know that the problem is temporary and will definitely be resolved when the child is older. Use training pants instead of diapers. Make sure it's easy to go to the bathroom at night by arranging a reasonable night light. Have a set of pajamas, sheets, and towels on hand so that your child can conveniently change linens and dirty clothes if he or she wakes up from bedwetting. Cover the mattress with nylon or waterproof sheet to avoid damaging the mattress. It is recommended to shower daily in the morning so that there is no urine smell. Praise and reward your child if he or she wakes up after a night of bedwetting. Even a small gift is an encouragement to a child. Constipation needs to be treated thoroughly.

6.2. Limit drinking water

Limit the amount of liquid (including water, milk, juice ...) that the child drinks from two to three hours before bedtime, but make sure to have enough fluid during the day. Avoid caffeine (tea, coffee), carbonated drinks (cola) and chocolate in the evening. They can increase the need to urinate and worsen bed-wetting.

6.3. Disable bedwetting

Create a habit of going to the toilet regularly during the day. Wake the child about three hours after he falls asleep each night to remove the urine. If necessary, use the alarm. By determining when your child is most bed-wetting, you can adjust the time your child wakes up to go to the bathroom.

6.4. Bedwetting alarm

Using alarms for bedwetting or high humidity is the most effective method of controlling bedwetting and is usually reserved for children over 7 years of age.
In this alarm, a sensor is attached to the child's underwear. When the child wets the bed in bed, the device will sense the first drops of urine, ring and wake the child. A awake child can control his or her urine output until it is time to go to the bathroom.
Alarms help train the child to wake up at the right time before bedwetting. However, its flip side also affects children's sleep.

6.5. Bladder training exercises

Many children with bedwetting often only urinate a little at a time even when the bladder is not full. The goal of bladder training is to increase bladder capacity. During the day, children are asked to drink large amounts of water and hold their urine even though they want to urinate. With practice, children can hold urine for longer periods of time. This will strengthen the bladder muscles and will increase bladder capacity.

6.6. Drug treatment

The drug is used as a last resort to end bedwetting and is usually only used in children over seven years of age. These methods work, but do not “cure” bed-wetting. Bedwetting often recurs when the drug is stopped. The likelihood of a permanent cure with bedwetting alarm is higher than with medication.
Medications used to treat nocturnal enuresis include:
Desmopressin Acetate (DDAVP): Desmopressin tablets are commercially available and are prescribed when other methods have failed. This medicine reduces the amount of urine produced at night and is only helpful in children who produce large amounts of urine. When your child is taking this medicine, remember to reduce the amount of water you drink at night to avoid side effects. This medication is usually given at bedtime and should be avoided at night when children drink a lot of fluids. Although very effective, this drug is rarely used due to its high cost. Imipramine: relaxes the bladder and tightens the sphincter, thereby increasing the bladder's ability to hold urine. This medicine is usually used for about 3-6 months. Due to the rapid effect, the drug is taken one hour before bedtime. This drug is highly effective, but because of frequent side effects, it should be used selectively. Side effects may include nausea, vomiting, weakness, confusion, insomnia, anxiety, palpitations, blurred vision, dry mouth, and constipation. Oxybutynin: (an anticholinergic drug) is useful for daytime bedwetting. This medication reduces bladder contractility and increases bladder capacity. Side effects may include dry mouth, facial flushing, and constipation. In addition, the doctor may prescribe some antibiotics in the following groups if your child has a urinary tract infection such as Bactrim, Amoxicillin, Macrobid, Levaquin.

7. What to do when the child often wets the bed at night?

Limit water in the evening. It's important to stay hydrated so there's no need to limit how much a child can drink in a day. However, encourage drinking water in the morning and early afternoon, limiting fluids in the evening. But don't limit evening fluids if your child is engaged in sports or playing games in the evening. Avoid drinks and foods with caffeine. Drinks with caffeine are not recommended for children at any time of the day. Because caffeine can irritate the bladder. Encourage urinating before bedtime. Double urination is urinating at the start of the bedtime routine and then urinating again just before falling asleep. Remind your child that you can go to the bathroom at night if needed. Use a small night light, so your child can easily find the passage between the bedroom and the bathroom. Encourage frequent use of the restroom during the day. During the day and evening, suggest that your child urinate every two hours or at least often enough to avoid the urge to urinate. Prevent Inflammation: To prevent infection from wet underwear, help your child wash his or her bottom and genitals every morning.

8. Some natural remedies for bedwetting in children (according to western concept)

Cinnamon helps to keep the body warm. You can give your child a piece of cinnamon to chew once a day. Indian burdock (Amla) is considered a very effective remedy for bedwetting. You can give your child crushed amla and seeds in a teaspoon of honey with a little turmeric every morning. Massage with olive oil: Massaging the abdomen area with warm olive oil for a few minutes is another home remedy to overcome bed-wetting. Cranberry juice: It is good for the bladder and urinary tract. You can give your child 1 cup of cranberry juice for a few weeks. If your child's bedwetting is caused by a UTI, give him 1.5 cups of juice a day. Walnuts and raisins: Can also be given to children as a snack. Children should eat two walnuts and five raisins before bedtime.

9. When to take your child to the doctor for a child with bedwetting

There is a problem with daytime bedwetting. Continued bedwetting after age 7 or 8. Start bedwetting again after at least 6 months without bedwetting. Loss of bowel control or fecal incontinence. Fever, pain, burning and frequent urination, unusual thirst, and swelling of the face and feet. Little urine, difficulty urinating or straining to urinate. Bedwetting is a normal development in children, parents should not be too worried. However, if your baby has a fever or painful urination, you should take him to a medical facility for early examination and treatment. Vinmec International General Hospital is one of the few medical facilities with a urologist at the Pediatric Department, providing intensive examination and treatment for children. Here, the child will be examined by experienced and highly qualified doctors who have successfully examined and treated thousands of pediatric cases of urinary tract diseases with the latest protocols. the world's most advanced.
If you have a need for urology examination for children at Vinmec, please book an appointment at the website or contact the hotline for detailed advice.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

Articles refer to sources: babycenter.com, mayoclinic.org, kidneyeducation.com, parenting.firstcry.com