Bed Wetting in Children

What is normal?

Of course babies wet their nappy (diaper) at any time. Becoming ‘dry' is a complex process. The urine-producing system has to develop its ability to produce less urine at night, coordination has to develop between the maturing nerves and muscles controlling the bladder, and the ability to wake up when the bladder is full also has to develop. All this takes time. This happens quite quickly in some children, but is slower in others. Boys tend to be slower than girls, so bed-wetting is three times more common in boys than in girls.

·         By the age of 2 years, most children are dry during the day (if a toilet is nearby when they need it, and their clothing is easy to undo).

·         By the age of 3 years, 3 out of every 4 children are dry most nights.

·         By the age of 5 years, most children are dry at night. However, 1 out of every 10 children still wets the bed at least once a week.

·         By the age of 10 years, about 1 out of every 15 children wets the bed several nights a week.

·         By the age of 15 years, only 1 out of every 100 children is still wetting the bed several nights a week.

These facts and figures show that most children gradually grow out of bed-wetting, and it is certainly nothing to worry about in a child younger than 5 years. The medical term for bed-wetting is enuresis, and this is usually defined as wetting the bed at least three nights a week in a child over 5 years of age.

Important points about bed-wetting

·         Your child cannot help wetting the bed.

·         Your child is not wetting the bed out of spite, or to attract attention, or by being too lazy to get out of bed.

·         Try not to get irritated, and don't criticize your child for bed-wetting. Punishing a child for bed-wetting certainly won't help, and may make it worse.

·         You and your child may feel depressed about the bed-wetting, and may feel it will never stop. Keep reminding yourself that most children grow out of it - think of it as a temporary problem.

Causes of bed-wetting

The exact reasons for bed-wetting are not very well understood, but here are some possibilities.

·         Bed-wetting seems to run in families - the likelihood of a child wetting the bed is 40% if one parent suffered and 70% if both parents suffered. So there is often a genetic element.

·         One of the most common reasons for bed-wetting is the bladder muscle contracting and emptying the bladder when it is only half full of urine. This is because the child is just being slightly slow in developing the necessary nerve and muscle control - there is nothing wrong.

·         Some children produce a lot of urine at night, because the mechanisms that reduce urine production at night are slow to develop - again, there is nothing actually wrong.

·         There is very little scientific evidence to back up the idea that bed-wetting is a psychological problem. Some children do wet the bed if they have anxieties at home or school, but more often bed-wetting is a cause (rather than a result) of unhappiness.

·         Parents often think that their child has a different, deeper sleep pattern than other children. There is no scientific evidence for this. The problem is more a difficulty with waking - the sensation of a full bladder is not enough to wake the child.

·         According to a report in New Scientist (2nd August 2003), breathing problems caused by the roof of the mouth being narrow may result in bed-wetting. This is why bed-wetting often improves after children have their tonsils and adenoids removed. More research on this is needed, but doctors are trying a special device, similar to a brace, to widen the roof of the mouth.

·         Organic causes:

            a) Spina Bifida or other lower spinal cord lesions

          b) Congenital anomalies of the genito-urinary tract especially the urethral valve.

          c) Cystitis, tuberculosis or other infection of urinary tract

          d) Diabetes Enuresis

          e) Lack of physiological development of the splincter vesicae or excessive irritability   

          of bladder

          f) Convulsive seizures

          g) Worms like ascarides are very frequent cause for enuresis

          h) Phimosis, rectal fissures and polypi.

          i) Excessive acidity or intake of excessive quantities of water in the evening.

Constitution of the children

Children of pseudo-psoric or tubercular constitution that is, having a combination of psora and syphilis suffer from bed wetting.

Do's:

1) Stay calm, be prepared and try not to worry.

2)  Encourage your child for staying dry; give awards for dry nights.

3)  Encourage the child to drink plenty; it is important that they recognize the feeling of full bladder.

4)  Avoid fizzy drinks, tea, coffee, chocolate; these can irritate bladder and can cause more urine production.

5)  Ensure that the child goes to toilet before bed. Make sure that easy access to toilet is available at night.

6)  Allow the child to help with changing the bed; this helps them to understand the problem and overcome it.

7) Make sure that the child has a bath each morning. This removes the smell of urine and avoids the child being teased at school.

Don'ts:

1) Do not get cross with your child; it is not their fault.

2) Do not use waking the child as a long term strategy to overcome bedwetting; instead get help from a doctor.

3)  Don't give up. 99% of these children get better by adulthood.                                        

THERAPEUTICS OF BED WETTING

ARGENTUM NIT: Enuresis in children who crave sugar, salt and more prone to acidity, Incontinence of urine at night & also at day time. Urine passes unconsciously, too profuse flow & pale urine. Great nervousness, child likes open air and worse in high places.

AETHUSA.CYN: Nocturnal enuresis with vomiting of coagulated milk after sucking bottle, greenish watery diarrhea. Child is very much weak, cannot bear milk in any form.

BELLADONA: Restless sleep with sudden start moaning & screaming during sleep. Involuntary urination when deeply asleep, generally after midnight & towards morning. Useful in self-willed, nervous children with fair complexion, who do not sleep on back, but sleep with arms over the head. Peculiar symptom of this remedy sensation of motion of worms in bladder.

CALC .CARB: Fat, flabby children with red face frequent urination at night & when walking. Child is very sensitive to cold, delayed in mile stones, craves for eggs, and undigested food particles, open fontanelles, delay ossification of bones, sensitive to cold weather.

CAUSTICUM: Enuresis due to weakness or paresis of bladder, child is unconscious of urine as it passes, involuntary micturition when coughing and sneezing at night when as sleep. Child is worse from cold dry weather and better in wet weather.

CINA: Enuresis due to worm troubles, urine is copious and which turn milky on standing, child is cross, ugly and wants to be carried, asks for things which he throws away when offered. Worm symptoms of grinding of teeth at night and boring of nose with fingers.

EQUISETUM : Important remedy for bed wetting in children especially when enuresis is rapid. Children with dreams or nightmares when passing urine, severe dull pain in bladder, it is remedy of choice for cystitis when general aggravation after urination.

HYOSCYAMUS: Frequent micturition with scanty discharge, involuntary, though he gets up several time during night which breaks his rest & make him feel miserable. Lascivious mania, want to be naked.

MERCURIUS: In children who perspire profusely & whose urine is hot, acrid, sour-smelling, irresistible desire to urinate. Child is easily frightened with hurried and rapid speech, All complains are aggravated from sunset to sunrise. Tongue swollen flabby takes imprints of teeth. Aggravation at night.

KREOSOTUM: Chilly baby easily affected by cold, child looks older than he is really, enuresis in baby during first sleep, from which the child is aroused with difficulty. Aggravation in cold weather, from washing and bathing in cold water.

RHUS.TOX: Very chilly patient, very restless child must change position frequently. Triangular red-tipped tongue with imprint of teeth and bitter taste. Great apprehension at night, cannot remain in bed in one position. Involuntary urine at night and when at rest. Urine is dark turbid and high colored with white sediment. Voided in large quantity during damp cold weather.

SEPIA: Child wets the bed as soon as he goes to bed. Sudden desire and tenesmus in girls. Sepia child is indifferent and has sallow complexion. Urine is offensive, red, adhesive and has sand deposits.

SQUILLA: Especially for cachectic children who have trouble from worms. Inability to retain the urine on account of abnormal irritation of lining of bladder,

THUJA: Enuresis in sycotic children, especially due to ill-effects of vaccination. Frequent urination accompayning pains, sudden desire to urinate cannot wait to control. Enuresis due to paresis of spinchter vescicae. Involuntary urination at night or when coughing.