By Dr. Goke Akinrogunde
One event that is worth sharing on this page was the case of a troubled mum and her eighteen year old daughter who came calling at my clinical setting during the week. Their concern is about what measures to take on the young lady, an university undergraduate, who has not been able to go dry since birth to the embarrassment of the parent and self. Although bed wetting at that age bracket may not be so common, as the statistics outlined below shown, but nevertheless presents as spot cases here and there. Here goes the basic understanding of bedwetting in children and the grownups.
Bedwetting, a condition referred to medically as NoCturnal Enuresis (pronounced “en-yur-ee-sis”), is quite common in homes; it remains the most common child-health issue. Bedwetting here refers to involuntary passage of urine while asleep after the age at which bladder control would normally be anticipated to have occurred.
Generally, most children begin to stop bedwetting at night around three years of age. Meaning that when a child has a problem with bedwetting after that age, parents may become concerned but it needs to be stressed that many other factors aside the child’s age will determine when a child will stop bedwetting.
At this point, it is also important to emphasise that bedwetting is not so much a disease, but a symptom, and a fairly common one for that matter; although it is pertinent to note that occasional bedwetting accidents may occur, especially when a child is not feeling well.
Points of fact about bedwetting
Here are some basic facts we should know about bedwetting. Approximately 15 per cent of children still wet the bed after the age of three; Many more boys than girls wet their beds and in children of the same age, more girls stopped bedwetting than the boys. Most girls can stay dry by age six and most boys stay dry by age seven; Approximate bedwetting rates with age are: Age 5: 20 per cent, Age 6: 10 to 15 per cent, Age 7: 7 per cent, Age 10: 5 per cent, Age 15: 1-2 per cent, Age 18-64: 0.5 – 1 per cent
Bedwetting tends to run in families. Many children who bedwet have parent (s) who did, too. It is also noted that most of these children stop bedwetting on their own at about the same age their parents did. Usually bedwetting stops by puberty. Most bed-wetters do not have emotional problems.
However, it is necessary to say that persistent bedwetting beyond the age of three or four rarely signals a kidney or bladder problem.
Types and causes of bedwetting
Enuresis is normally described in two broad terms: Primary nocturnal enuresis (PNE) and Secondary nocturnal enuresis (SNE). Primary nocturnal enuresis (PNE) is when a child has not yet stayed dry at night on a regular basis while Secondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry, especially if such a child has not bedwetted for up to six months before a new onset of bedwetting.
While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying disease. In fact, a definite underlying disease-cause is identified in only about one per cent of children who wet the bed. However, this does not mean that children who wet the bed do so purposely. Such children who wet the bed are not to be seen as lazy, willful, deliberately disobedient or indolent.
In general, primary bedwetting probably indicates immaturity of the nervous system. A bedwetting child does not recognize the sensation of the full bladder during sleep and thus does not awaken during sleep to urinate into the toilet.
The cause is likely due to one or a combination of the following:
.The child cannot yet hold urine for the entire night.
.The child does not waken when his or her bladder is full.
.The child produces a large amount of urine during the evening and night hours.
The child has poor daytime toilet habits. Of relevance here is to note that many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents are familiar with the so called “potty dance” characterized by leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.
On the other hand, secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting.
Common causes of secondary bedwetting include the following:
1. Urinary tract infection: this leads to bladder irritation which can cause lower abdominal pain or irritation with urination; it can also cause a stronger urge to urinate (called urgency) that can actually make an individual to pee on the body before getting to the toilet even during day time wake period. Urinary infection can also lead to frequent urination (frequency). Although, it should be noted that Urinary tract infection in children may itself indicate another problem, such as an anatomical abnormality.
2. Diabetes: People with type I diabetes, commoner in children than adults, have a high level of sugar (glucose) in their blood. The body increases urine output as a consequence of excessive blood glucose levels. Having to urinate frequently is a common symptom of diabetes.
3. Sometimes, there are structural or anatomical abnormalities in the organs, muscles, or nerves involved in urination which can cause incontinence or other urinary problems that might present as bedwetting.
Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.
Emotional problems: A stressful home life, as in a home where the parents are always quarreling or in conflict or divorced, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting. Children who are being physically or sexually abused sometimes begin bedwetting.
Abnormal sleep patterns: Obstructive sleep apnea (characterized by excessively loud snoring and/or choking while asleep) can be associated with enuresis.
Pinworm infection: an infection with pinworm characterized by intense itching of the anal and/or genital area may also leads to bedwetting.
Excessive fluid intake.
Bedwetting symptoms – beyond the ordinary
Most people (80 per cent) who wet their beds, wet only at night. They tend to have no other symptoms other than wetting the bed at night.
Other symptoms could suggest psychological causes or problems with the nervous system or kidneys and should alert the family or the doctor that this may be more than routine bedwetting
.Wetting during the day
.Frequency, urgency, or burning on urination
.Straining, dribbling, or other unusual symptoms with urination
.Cloudy or pinkish urine, or blood stains on underpants or pajamas
.Soiling, being unable to control bowel movements (a condition known as fecal incontinence)
Although, it is important to note that frequency of urination is different for children than for adults. While many adults urinate only three or four times a day, children urinate much more frequently, in some cases as often as 10-12 times each day; hence, ‘frequency’ as a symptom should be judged in terms of what is normal for that particular child.
When to see the doctor for bedwetting
When to involve a doctor or other care-giver is variable and depends on many factors – most commonly it is based upon how the situation is affecting the child as well as the parents or child’s guardian. It may be advisable, however, to consider the following parametres to determine when it may be okay to see the doctor, especially if the child displays only nighttime wetting without any other symptoms: It is probably a good time to seek medical help when the child is 5-7 years of age.
A specialist attention may be required earlier if other symptoms developed along the lines mentioned earlier in the preceding passages. A child should be checked without delay for an underlying medical problem if he or she develops any other physical or behavioral symptoms.