Mama, I wet my bed

Enuresis refers to a repeated inability to control urination, and it is not uncommon in children.

BEDWETTING, or its medical term “enuresis”, is not uncommon. It is NOT the child’s fault – it is a disease that both parents and the health profession should be aware of.

According to the International Children’s Continence Society’s guidelines, nocturnal enuresis is the involuntary passing of urine whilst asleep in a child five years or older.

Some children wet the bed once a month, others more often, and some, every night.

The prevalence rate for bedwetting varies from about 10% in six-year-olds to 5% in 10-year-olds.

Some children also wet their pants during the day, and this is referred to as daytime incontinence. Daytime incontinence is more common in girls; night-time bedwetting alone is far more common in boys (1.5 to 2 times more in boys compared to girls).

Some 15% of bed-wetters do recover spontaneously.

Current research has shown that many bed-wetters produce exaggerated amounts of urine at night as they do not produce enough antidiuretic hormone. Thus, the urine produced exceeds the bladder capacity (akin to pouring 500ml water into a 200ml cup).

Some bed-wetters suffer from an overactive bladder muscle, known as detrusor muscle overactivity. These children have small bladders, will pass small amounts of urine and do so very frequently.

Parents of bed-wetters will often complain it is very difficult to arouse the child from sleep. Sleep studies have shown impaired sleep – poorer sleep quality, shorter periods of continuous sleep and restless limbs during sleep. They also tend to be more sleepy in the mornings and evenings.

To overcome the problem, both parents and doctors must realise that bed-wetting is a disease and needs treatment. It’s not a matter of the child outgrowing it, especially in severe cases.

Evaluation consists of taking a good history of the child’s urinating habits, how much he/she drinks during the day and at night, other urinary problems, and if there’s any constipation.

Once it’s clearly established that it is nocturnal enuresis, simple advice such as regular urinating every three hours (about six times daily) and adequate fluid intake during the day is advocated.

Initial first-line treatment can be enuresis alarm or medication.

In well-motivated families, the enuresis alarm method’s success rate is 60-70%, but it does have a relapse rate of about 5-30%. It requires a very compliant and well-motivated child and parents.

Another mode of treatment is medication. A syntheti gue of the antidiu tic hormone called desmopressin is used, and its success rate is about 40-80%.

Response is immediate. However, the relapse rate can be high. Those children that do respond and who have relapsed can continue desmopressi for a period of time or take it intermittently.

However, the child must not take a lot of liquids at night when taking desmopressin.

Children resistant to both therapies should be referred to specialists. They need to be re-evaluated as more detailed investigations and individualised therapy may be necessary. As with many diseases, genetics do have a role in enuresis, and research is being carried out on this.

If one parent was previously a bed-wetter, his/her child has a 40% risk of being a bed-wetter; if both parents had been enuretic, the child’s risk rises to 70%.

It is important to manage enuretic children well. Parents or caregivers should not reproach or punish bed-wetters. Many enuretic children may think bed-wetting is their own fault. It is very important to inform the child this is not the case As one expert p o is young pati r bladas smart as ou (the child), hence you wet the bed at night.”

This article is courtesy of the Malaysian Association of Paediatric Surgery. For further information, e-mail starhealth@thestar.com. my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.