Nocturnal enuresis or bed-wetting can go on and on and actually affects up to 2.3% of adult men and women. With a variety of causes responsible for this condition, its treatment depends strongly on the nature and origin. This article focuses on some of the major causes and management options for bed-wetting.
What is nocturnal enuresis?
Involuntary urination while asleep after the age at which bladder control should have occurred is known clinically as nocturnal enuresis or simply bedwetting. It is one of the most common conditions affecting children. It may be caused by either developmental delay or specific medical conditions. About 5% of children older than ten years and between 0.5% and 2.3% of adult men and women experience nocturnal enuresis or bedwetting.
Types of nocturnal enuresis (bedwetting)
Clinically, bedwetting is classified as either primary or secondary. Primary bedwetting refers to a condition in which the child or adult has never had a prolonged and continuous dry spell while asleep while secondary bedwetting refers to where despite an earlier dry spell, bedwetting recurs. Primary bedwetting is more prevalent than secondary bedwetting.
Causes of nocturnal enuresis
a) Emotional stress – Psychological trauma resulting from stressful conditions such as death of a close relative, sexual abuse or bullying can lead to bedwetting.
b) Bladder infection – Urinary tract infections such as cystitis are associated with 5% of bedwetting cases.
c) Developmental delay – Handicapped children or those that are mentally retarded show increased incidence of bedwetting.
d) Genetic constitution – Bedwetting sometimes runs in the family. Children with a history of bedwetting in the family may not escape the condition. Scientists have even isolated the genes responsible for nocturnal enuresis.
e) Physical abnormalities – Physical abnormalities such as a smaller than normal urinary bladder contributes to bedwetting because the bladder tends to fill faster.
f) Insufficient ADH production – Anti-diuretic hormone or vasopressin regulates the amount of urine produced by stimulating re-absorption of water from urinary tubules back into the blood.
g) Constipation – The pressure exerted by the large intestines onto the urinary bladder during constipation may lead to bedwetting.
h) ADHD – Attention deficit hyperactivity disorder which affects some children particularly those constantly exposed to organic pesticides increases bedwetting probability almost three times.
i) Caffeine and alcohol consumption – Caffeine found in coffee and ethanol found in alcoholic beverages inhibit ADH (Anti-Diuretic Hormone) production hence increasing the amount of urine produced and the frequency of urination.
j) Improper toilet training – Forceful toilet training while a child is still too young may contribute to psychological fixation that contributes to bedwetting.
Management of nocturnal enuresis
Most parents make bedwetting worse by severely beating children who urinate in bed making the problem extend into adulthood. The following management options may control bedwetting.
a) Patiently waiting for the child to outgrow bedwetting behavior – Most children who are treated with patience and counseled usually outgrow bedwetting before reaching puberty.
b) Desmopressin prescription – Desmopressin is a synthetic equivalent of anti-diuretic hormone (ADH) which can be given to individuals with ADH deficiency.
c) Use of alarms – Bedwetting alarms can be used to wake a child or an adult upon sensing moisture or bladder fullness.
d) Dry bed training – Waking up children or affected adults to drain their bladder at fixed intervals whether or not their bladder is full may assist in controlling bedwetting.
e) Use of tricyclic antidepressants – A group of antidepressants know as tricyclic antidepressants can be prescribed as a treatment option for bedwetting.
f) Use of diapers – If all fails, if all the five named options fail, use of diapers irrespective of the age may manage nocturnal enuresis or bedwetting.