Understanding Bedwetting in Children

Understanding Bedwetting in Children 

~ Co-authored by Dr. Kedar Tilwe, Consultant Psychiatrist, Fortis Hospital Mulund & Hiranandani Hospital, Vashi & Dr. Asmita Mahajan, Consultant Neonatologist & Pediatrician, SL Raheja Hospital, Mahim ~ 

 
Bedwetting, medically known as enuresis, is a common concern among children and their parents. To effectively address this issue, it's crucial to understand its types, causes, and how it can be managed. Bedwetting is considered to be a problem if it occurs at least twice a week in children who are older than 5 years of age. Bedwetting in children usually is distinguished into two types. 

• Primary Bedwetting: 

It refers to the inability to achieve bladder control since birth. This means that the child has never experienced dry nights consistently. According to some theories, this may be caused due to hormonal imbalance, brain dysfunction affecting the urination center, or genetic predisposition. If one parent has a history of bedwetting in their childhood, the child has a 40 per cent chance of bedwetting and if both parents have a history, then the chance is even higher which is nearly up to 70 per cent. 

 Secondary Bedwetting: 

On the other hand, secondary bedwetting occurs when a child, who previously achieved bladder control, begins bedwetting again after a period of dryness. Secondary enuresis is often associated with situational stress, anxiety, or emotional discord. It is caused due to reasons such as urinary tract infections (UTI), constipation, or structural abnormalities in the urinary system. Diabetes, sleep disorder, or hyperactive urinary bladder. Additionally, psychological and behavioural issues such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders may contribute to bedwetting. 

 
When addressing bedwetting in children, a thorough assessment is important. This involves gathering detailed information about the child's urinary habits, bowel movements, growth parameters, behavioural problems, and any associated symptoms. Diagnostic tests, including sonography and blood tests, may be necessary to rule out these medical conditions. The warning signs also include the detection of glucose, protein, or WBCs in the urine.  

There are some ways in which bedwetting can be managed like behavioural therapy, including motivational techniques and scheduled voiding, which can be effective in improving bladder control. The other way of managing bedwetting that can be used is the treatment alarm, which helps wake the child up after detecting wetness. In some cases, medication can also be prescribed, particularly for resistant cases or those with underlying medical conditions contributing to bedwetting. Thus, it is necessary to consult a pediatric specialist before starting any medical treatment. 

Parents have a critical role in assisting children with bedwetting problems. They should not criticize or shame the child for bedwetting. Instead, encourage regular urination throughout the day and make sure that the child empties their bladder before bedtime. Regulating the child's fluid intake, with a focus on proper hydration during the day and limited intake in the evening, and encouraging a balanced diet rich in fruits, vegetables, and whole grains, while limiting sugary and caffeinated beverages, avoiding high sugar, carbohydrate, and caffeine-based or even carbonated drinks, can help children with bedwetting. Parents can ensure 40 per cent fluid intake in the morning, 40 per cent in the afternoon, and only 20 per cent in the late evening. 

 Bedwetting is a common concern in children, but with understanding and appropriate management, it can be effectively addressed. By distinguishing between primary and secondary bedwetting, identifying potential causes, and implementing tailored management strategies, parents and healthcare providers can support children in overcoming this challenge and promoting better bladder control and overall well-being.