HEALTHNET

To what age should parents be concerned bed-wetting in a child?

For a diagnosis of enuresis, wetting should occur more than twice a week for at least three months with no underlying physiological cause.

(Posted on 4 January 2007)

Q1. To what age should parents be concerned bed-wetting (enuresis) in a child?

A1. Bedwetting is involuntary urination while asleep. It is the normal state of affairs in infancy. About 40 percent of 3-year-olds are wetting their bed. By age 5, 80% to 85% of children are consistently dry throughout the night. Occasional accidents are common. For a diagnosis of enuresis, wetting should occur more than twice a week for at least three months with no underlying physiological cause. The American Psychiatric Association defines enuresis as repeated voiding of urine into the bed or clothes at age five or older. However some experts would only consider bed-wetting a medical problem only after the age of 6. By then only about 10% of children would wet the bed about once a month.

Bedwetting often causes problem socially when the child is in primary school. Parents are also more likely to be upset if a child starts wetting the bed after a period of dryness at night. Statistically, about 15% of children with the problem would stop wetting on their own each year. However, 1% of 18-year-olds still continue to wet their beds.

Q2. What factors contribute to bedwetting (enuresis)?

A2. The bladder is a muscular bag that expands as urine is passed from the kidneys. When the bladder is full, nerves in the bladder wall would send a signal to the brain, which produces an urge to urinate. Until it is socially acceptable to do so, the brain would send a back message to the bladder to stop it from emptying.

The need to void at night would therefore be affected by:

The size and activity of the bladder
Children with small bladder may not be able to hold large amount of urine. Infection in the urinary tract can also cause irritation and spasmodic muscular activity in the bladder that result in involuntary voiding.
The amount of urine formed at night
Our urine output at night depends on the amount of fluid taken in the evening and the relative activity of a hormone that inhibit urine output. Some people may not be producing enough of the hormone and hence are producing too much urine while sleeping.
The depth of sleep
Some children are sleeping more soundly than others, and hence are more liable to wet the bed. Bedwetting is also more common in people with sleep disorders.
Genetics
Bedwetting is more common in boys. Teens with enuresis often have a parent who had the same problem at about the same age.
Maturation
The ability to stay dry at night is a social skill that needs to be mastered. Children may vary in the rate they achieved this milestone. Bedwetting is also more common in children with hyperactivity.

Q3. My 6-year-old son has never been dry at night. What treatment options are there? Will he recover?

A3. You should bring your child to see a paediatrician to evaluate for possible causes of his problem. If none is found, most doctors would suggest a program of "motivational therapy". Never punish or scold your child with bedwetting. Undermining his self confidence would aggravate the situation. Instead, reward him with a token for any of his effort to achieve a dry night. Give him a token, and offer a treat of his choice after having collected enough of them. You should offer some help to start with, by limiting his fluid intake at evenings and waking him up to void at night.

Some cooperative children may be helped with a bedwetting alarm. A sensor is attached to the underwear that triggers an alarm before the child actually urinates. If everything fails medications are available to help. The most effective ones work by preventing the formation of urine at night. Unfortunately the problem often return after the child has stopped taking the drug. Nevertheless the drug can help a child to stay dry in school camps.

Statistically about 10% of 6-year-old children wet the bed about once a month, but only 1% of adolescents experience enuresis. So your son has a pretty good chance to grow out of his problem.

Source: Quality HealthCare