Even though it is very common during childhood, it should be evaluated further in case of prolonged bed wetting even after 5 years. Bed wetting occurs more commonly in boys aged 4-11 years than girls. Most of the parents think that bedwetting is due to laziness which is not the actual cause.
Cause can be due to physical or psychosocial factors. If the child spends all day under strong pressures whether from parents or from school. Major reasons include:
- Stressful homelife and conflict between parents
- Poor daytime toilet habits
- Urinary tract infection
- Down’s syndrome
- Attention deficit hyperactivity disorder
- Deep sleep and arousal disorder
- Congenital malformations of genitourinary tract
- Chronic constipation in which full bowel will put pressure on bladder
- Slow development of bladder control
- Urine analysis is the first step in which we check the pus cells, protein, casts and glucose to rule out urinary tract infections and renal disease.
- Random blood sugars are checked to rule out diabetes.
- Urine culture is based on the urine analysis report.
- Children with complicated enuresis may need further evaluation with renal ultrasound and voiding cystourethrogram.
- Reassurance is the best approach for both the child and parents.
- Avoid punitive measures that can affect child’s psychological development adversely.
- Fluid intake should be restricted to 60ml after 6-7pm.
- Parents should be certain that the child voids at bedtime.
- Avoiding sugars and caffeine after 4pm can also be helpful.
- Waking children few hours after they go to sleep can help them to wake up dry.
- The child should not be blamed for bed wetting.
- Praise the child and give them a star if they wake up dry.
- Some pharmacological measures are there to give short term relief but can be only advised by doctors, if the above measures do not work.
- If there is any underlying cause like diabetes or structural abnormalities, treatment is given to treat that first.