There is no doubt that bedwetting is the most common and frustrating childhood disorders. At the age of four 30 % of children still wet their bed.Also known as enuresis, bedwetting is involuntary urination after ages of four to five and could either be daytime, night time or both. Primary enuresis refers to bedwetting by a child who never stopped bedwetting or was dry for a short period. While in secondary enuresis; a child was dry for at least six months and relapsed.

Causes of bedwetting

Bedwetting is common in children who have not learned to activate the proper reflex system during their sleep. When one sleeps, and the pressure of urine is build up in the bladder, a signal is sent to the brain. Among children who wet their bed such signals are not recognized by the subconscious reflex system. The sphincter muscles are often relaxed hence bedwetting. Here are factors leading to bedwetting among children:

1. Diabetes

People with type 1 diabetes have high levels of sugar in the blood. The body increases urine output as a result of excessive blood glucose levels. Frequent urination is a sign of diabetes type 1.

2. Anatomical abnormality

Abnormality of the muscles, organs or nerves involves in urination may lead to incontinence resulting in constant bedwetting

3. Deep sleep

Most parents of bedwetting children claim that their children are unusually deep sleepers. Most of such children are disoriented, may not even sense being taken out of the room. Because of such deep sleep, the child might not sense bladder fullness.

4. Neurological problems

Abnormalities of the nervous system or injury to the head may cause neurological imbalance that controls the process of micturition

5. Dribbling

Dribbling is an involuntary discharge of urine. It is common for children of four to eight years. Dribbling is quite easy to treat; cognitive behaviour treatment teaches the child how to recognize signals from full bladder traveling to the brain and how to respond.

Dribbling during sleep is common. The child fails to recognize the signals from the bladder and relaxes the sphincter muscles starts to urinate and contracts the muscles immediately stopping urination.

  • The result of dribbling is usually wet spots on the child’s clothes which does not reach the child’s beddings.

Other causes of bedwetting include:

  • Excessive fluid intake before bed
  • Infection of the urinary tract

What should I do about my child’s bedwetting?

Do not be embarrassed of your child, the first step to finding help for your child is to talk with your paediatrician. Your paediatrician will then assess to rule out any medical cases as follows:

  1. Urine test may reveal increased glucose levels or urinary tract infection
  2. A physical examination may reveal constipation which may cause the abdominal muscles to push down those of the bladder resulting in continuous urinating.
  3. Your doctor may also take history of the child’s sleeping pattern to rule out sleep apnea.
  4. Your doctor may also counsel your child in case they appear as secondary bedwetting is sometimes as a result of depression.

Treatment options

How can one stop bedwetting effectively? Here are a few treatment options available for bedwetting:

1. Bedwetting alarms

There are several types of bedwetting alarms. All the bedwetting alarms make a sound at the first drop of urine as a result of the closed electric circuit. All these alarms are battery operated. There are three types of alarms:

Buzzers bedwetting alarms: they are attached to the child’s nightgowns connected to a wire to a small moisture sensor which is placed in the underwear near the child’s sexual organs.

Even though the buzzer alarms are affordable, they have the following disadvantages:

  • They are dangerous as the acidity of the urine may corrode the metal sensor which can cause bruising of the skin.
  • The child’s movement in bed may also result in skin irritation due to friction.
  • Some children may react to the metal sensor.
  • May be intentionally disconnected from the child
  • Sound may not be loud enough to activate the reflex system more in cases where the child’s blanket covers the alarm, dimming its sound

Wireless buzzers bedwetting alarms: This type of bedwetting alarms are not connected to the body. The typically wired buzzers use radio transmitters placed at the bottom of the child’s lower abdomen near the child’s sexual organ.

A radio receiver is installed in the alarm which is attached to the child’s sleeping gown or next to the bed. When the child tries to wet the bed, the radio waves are transferred from the transmitter to the receiver and the alarm is immediately activated.

Bed and pad alarms: These types of alarms are composed of two parts, the control unit (alarm) and the plastic detector pad which is placed on the bed under the sheet. The pad is then attached to the alarm using a thin wire. This does not disturb the child.

These types of alarms are safer, efficient and convenient than buzzers. Going by the fact that this type of alarm is more expensive to manufacture, bell and pad alarm may cost you an arm and a leg

2. Psychotherapy

Psychotherapy is only effective when the primary cause of bedwetting is psychological. Treatment in this type of therapy focuses more on the primary cause of the behaviour.

3. Behavioural treatment

This is the most effective therapy when it comes to bedwetting. The child is taken through different processes that are designed to teach him to activate the continence mechanism. The child sleeps with an alarm which starts to ring immediately they start urinating. The purpose of the alarm in this therapy is to activate the reflex system and induce the learning process.

The goal of the buzzer is to teach the child to restrain themselves not to teach the child how to wake up at night. If for instance, the child does not wake up at night, the alarm acts on the subconscious reflex mechanism.

  • The buzzer is vital since it measures the reflex response and assesses the child responds to treatment.
  • Behavioural treatment is 50 % effective.

4. Medication

Bedwetting treatment includes drugs such as desmopressin which works by limiting the amount of water that is eliminated in urine. Desmopressin is not highly recommended since it may lead low levels of sodium (salts) and seizures.

Other bedwetting medications such as imipramine and oxybutynin lead to a high relapse rate when the patient stops using the medication.

How to cope with bedwetting

Parents feel helpless when it comes to bedwetting. Bedwetting usually goes away on its own but may last for a while. Even though it can be embarrassing and uncomfortable for your child, you need to understand that it takes time to get away with bedwetting.

Here is how to cope with your child who is bedwetting:

  • Let your child drink more fluids during the daytime. Limit the number of fluids they take during evening hours or at night.
  • Reassure your child that bedwetting is part of growing up and that it never lasts forever.
  • Avoid waking up your child at night asking them to urinate on demand. That only leads to sleeplessness and frustrations
  • Encourage your child by consistently rewarding success.
  • Do not act offended by the smell of urine in the bedsheet; it can depress your child significantly.
  • Have your child avoid caffeine and any other diuretics. Drinks such as chocolate, coffee, and tea contain caffeine which promotes excessive excretion of urine.
  • Remind your child to go to the bathroom before bed
  • Do not punish your child when they wake up with wet sheets.

When to see a doctor

Bedwetting in the following instances may not be typical. Call your doctor if your child:

  • is drinking or eating more than usual
  • is seven years of age or older and still wets their bed
  • has to pee often
  • begins to wet the pants during the day
  • suddenly starts bedwetting after being dry for six months
  • has swollen feet and ankles

SOURCES AND REFERENCES

  1. Tips for better sleep (June 2016)

https://www.webmd.com/a-to-z-guides/discomfort-15/better-sleep/slideshow-sleep-tip

  1. Bed-wetting (May 2015)

https://www.mayoclinic.org/diseases-conditions/bed-wetting/diagnosis-treatment/drc-20366711

  1. How to stop bed –wetting (March 2015)

https://www.webmd.boots.com/children/features/bedwetting-solutions-how-can-you-stop-bedwetting