Nocturnal Enuresis / Bed Wetting
Nocturnal Enuresis or Bed Wetting as is commonly called, is an involuntary urination during sleep in a child older than 5 years of age. However it may not just be only nocturnal, may be also present during the day (in 25% of children). Normally 90-95% of children are nearly completely dry during the day and 80-85% by night by 5 years of age. It is a cause of substantial psychological distress in children and even their families.
The prevalence is difficult to assess in the Indian scenario as it may be hidden by most of the parents due to social stigma attached to it or would be just brought up as a secondary problem when the child visits the pediatricians’ clinic.
Nocturnal Enuresis should not be considered as a psychological issue, rather is a form of developmental delay or delay in achieving bladder control when most of the children of that age group would be dry during the night. It is commonly associated with family history of the condition ( in 50% of the cases) or maybe associated with stresses, e.g. new baby in home/change of place.
Constipation in children maybe the precipitating factor for nocturnal enuresis which should be addressed.
Enuresis has been classified as primary or secondary depending upon whether bladder control was once achieved by the child or not.
There are many treatment options available. A thorough history and physical examination is necessary.
The most important aspect of therapy is reassurance. Behavior and motivational therapy would help achieve dry nights in many kids. Bed alarms ( conditioning therapy) is the safest and effective mode of treatment. Medications may be required for other set of children who do not respond to other therapies.
The management should bring the child to ease so that he/she may be able to enjoy outings/camps with peer groups and should not become matter of shame for the child and family.