Bedwetting in children
Most children can control voiding by the age of five years. However, incontinence can occur in about 1% of those aged 18 years.
THE kidneys produce urine, which passes through the ureters to enter the bladder, a hollow and distensible organ that sits on the pelvic floor. The stored urine exits the body through the urethra, which is a tubular structure. This act (voiding) involves muscles, nerves, the spinal cord and the brain.
The bladder has two types of muscles. The detrusor muscle stores urine and contracts when emptying the bladder. The bladder sphincter is a circular group of muscles found at the bottom of the bladder. It automatically contracts to retain urine in the bladder and relaxes when the detrusor muscle contracts (when the urine gets into the urethra).
When the pelvic floor muscles contract, urine is held back in the bladder.
The newborn’s bladder fills up to a certain set level at which the bladder muscle contracts automatically, leading to voiding. As the newborn grows, his or her nervous system matures. The brain starts receiving messages from the filling bladder through the spinal cord and also sends messages to the bladder.
Eventually, the child is able to stop the bladder from voiding automatically until the child decides when and where to void.
When the control mechanisms are immature or fails, it results in bedwetting (incontinence). Most children are able to control voiding by the age of five years. However, incontinence can occur in about 1% of those aged 18 years. Incontinence is twice as common in males as compared to females.
There are certain medical terms used to describe incontinence in children:
> Primary enuresis is incontinence in someone who has never been dry for at least six months
> Secondary enuresis is incontinence that begins after at least six months of dryness
> Nocturnal enuresis is incontinence which occurs during sleep. It is also called night time incontinence
> Diurnal enuresis is incontinence which occurs when awake. It is also called daytime incontinence
There are several causes of bedwetting in children and they vary from the simple to the complex.
Nocturnal enuresis is more common than diurnal enuresis after the age of five years. The causes of nocturnal enuresis are not well clarified yet. Most cases result from a variety of causes that include slower phys- ical development, an increased production of urine at night, a lack of ability to recognise bladder filling when asleep, and, occasionally, anxiety.
Nocturnal enuresis between the ages of five and 10 years due to a smaller bladder capacity usually disappears gradually as the bladder capacity increases.
The body produces a hormone called antidiuretic hormone (ADH) which reduces the production of urine. As less ADH is produced at night, the need to void is less. Sometimes the body does not produce sufficient ADH at night, leading to the production of more urine. If a child does not sense the increased volume of urine in the bladder and awakens to void, bed wetting will result.
Anxiety has been suggested as a cause of bedwetting in children between two and four years of age when they have yet to achieve total control of their bladders. Anxiety after the age of four years can also lead to nocturnal enuresis after the child has been dry for six months or more. The anxiety-causing events include angry parents or relatives, birth of a sibling, and unfamiliar social situations.
Incontinence itself can cause anxiety. Diurnal enuresis can cause anxiety that leads to nocturnal enuresis.
A strong family history of bedwetting is suggestive of genetic causes. Studies have reported that a child has an 80% chance of bedwetting if both parents had been bed wetters.
There is a small group of children who have physical abnormalities in their urinary tract which lead to incontinence, e.g. a blocked bladder or urethra, and nerve damage associated with spina bifida, which is a birth defect of the spinal cord.
Diurnal enuresis is less common than nocturnal enuresis and usually disappears earlier than nocturnal enuresis.
An overactive bladder is one of the causes of diurnal enuresis. When the detrusor muscle of the bladder contracts strongly, the bladder sphincter may be unable to prevent voiding. This occurs frequently when there is a urinary tract infection (UTI), which is more common in girls because of their short urethras.
Many children who have diurnal enuresis have abnormal habits, the most common being infrequent voiding. They ignore the feeling of a full bladder and do not void for long periods for various reasons, e.g. not wanting to use the toilets at school. As the bladder is overfilled, the urine leaks. Such children are prone to UTIs, which in turn leads to an overactive bladder.
The causes of nocturnal enuresis may interact with infrequent voiding to lead to diurnal enuresis. These small bladder capacity,
abnormalities of Pressure from a distended when a child has constipation, caffeine-containing increase urine output,
There are various available. They include training, medicines, and moisture Most cases of bedwetting resolve spontaneously
as the child estimated that the wetting reduces by age of five years.
The body’s changes time include an increase
resolution of an normal production of anxiety provoking learning to respond time to void.
Bladder training help to strengthen bladder’s muscles. anticipate the need oneself when there
The methods used enuresis include determining