Enuresis (bedwetting) is an involuntary passage of urine caused by variety of factors. It can occur either during the day or at night (though some restrict the term to bedwetting that occurs at night). It is commonly known as bed-wetting. Nocturnal enuresis, or bed-wetting at night, is the most common type. Daytime wetting is called diurnal enuresis.Mixed enuresis is a combination of nocturnal and diurnal type, wherein urine is passed during both waking and sleeping hours.
Types: Bed wetting is classified in two types
1)Primary Enuresis: Bed wetting is sincechildhood
2)Secondary Enuresis: Bed wetting in children who have been trained to be continually dry for about minimumsix months, but revert to wetting again
Primary enuresis is mainly because of delay in maturation of the nervous system.At the age of five years normally children develop good control over bladder. Approximately 16-17% of children wet the bed once a month and male are twice likely as compared to females.
Primary enuresis is inability to recognize message send by nervous system that the bladder is full to the sleep arousal center of the brain while asleep. It is observed that bladder capacity is often smaller in children having primary enuresis and they don't awake when their bladder becomes full. The child cannot hold urine for entire night. There may be an emotional cause due to continuous conflict between parents which is not supported medically. Child that is suffering from sleep disorders or sleep apnea is at risk.Some children with symptomaticadenotonsillar hypertrophy may get some relief if tonsils and adenoids removed surgically operation called as Adenotonsillectomy.
Secondary Enuresis Secondary enuresis develops after being continually dry for about minimum six months. It may arises due to some other existing medical conditions listed below
1)Urinary tract infection which causes bladder irritation and leading to urgency or increased frequency
2)Type 1 Diabetes with increase blood sugar levels causingfrequent urination
4)Diseases, injury or abnormalities related to nervous system
5)External pressure on bladder for example rectal stool mass
Diagnosis can be done through:
1)Complete case history, repeated voiding of urine into bed or clothes with presence of clinically significant distress or impairment in social, academic activities
3)Laboratory investigations -urine culture, urinalysis to rule out urinary tract infection or kidney disease
4)X-ray/Ultrasound of kidney and bladder(KUB) if physical problem is suspected
Many parents and children are frustrated with bed-wetting mainly because it affects the self-esteem or social events like camp attendance or sleep over.
Few others suffer from extreme anxiety or fear or even restlessness. The cure for primary bed wetting is "passage of time" but one should always take consultation of physician
who can differentiate between primary and secondary enuresis before starting specific treatment. Special patience is required for toilet training a child.
Encouragement and reassurance work very good for some children.
Few points listed below will help in the management for bed-wetting
1)Restrict fluid intake before bed and encourage voiding prior to bed time.
2)To prevent mattress from getting wet cover the mattress with plastic.
3)Absorbent underwear, diapers can reduce embarrassment for bed wetters but extended diaper usage may interfere with learning to stay dry at night.
4)Bed wetting alarms is a device which senses the urine, wakes up the child so he/she can use the toilet. It is mostly for older children and are available at most pharmacies. But the rate of cure is variable.
5)Pelvic floor and bladder stretching exercises to strengthen the muscles that controls the release of urine.
6)Medication-such as Desmopressin Acetate or Antidiuretic Hormone(DDAVP) and Imipramine(Tofranil).
Homoeopathic Medicine for Bed Wetting
Homoeopathic line of treatment can help out parents and child from not only the disorder, but also the self-esteem and embarrassment. The cure can be rapid, gentle and permanent. These medicines don't have any side-effects.
Arsenic Album: The typical Arsenic child is anxious, restless and fastidious in nature. They will get out of bed to put a chair straight in order. We can think of arsenic album when bed wetting is more between time modalities like 1-2 am.
Causticum: is indicated whenbed wetting is more in winters and gets better in summers. Urine passes so easily that the patient remains unaware of it; there is little control over the bladder. Child is weak and wets the bed early in the night. Urine may escape even when the child coughs or sneezes and on slightest excitement. There is little sensation while passing urine
Kreosotum: Childexperiences a very sudden urge to urinate and go quick enough. Patient has a sudden urging onset during the first deep stage of sleep causing bed wetting. Patient with urging but cannot retain the urine or sometimes patient think he/she is passing urine in dreams and to actual bed wetting.
Lycopodium: is indicated when the child has involuntary urination during sleep. Mainly in enormous or larger quantities of clear urine. Sometimes red sand in their urine is observed. The child craves for hot drinks and most complaints are aggravated between 4-8 pm. They often present a bad mood on waking.