Bedwetting in Children
Article contributed by:
Dr Siow Woei Yun,
Specialist, Urology,
Raffles Hospital
for New Dimension -
biannual newsletter of
the
Society for Continence,
Singapore
Young children pass
urine involuntarily.
Daytime control of the
bladder usually occurs
by 3 years old, while
night-time control of
the bladder usually
occurs by 5 years old.
Lack of bladder control
beyond the age of 5 is
called enuresis.
When this occurs both in
the day and at night, it
is known as diurnal
enuresis. When
this occurs at night
only, it is known as
nocturnal enuresis or
more commonly,
bedwetting.
Children who have never
been dry for periods
longer than six months
have primary enuresis,
while children who
re-experience urinary
leakage after achieving
bladder control have
secondary enuresis.
Approximately 15% of
children continue
wetting beyond the age
of 5 and this decreases
to 5% after the age of
10. In general,
enuresis affects more
boys than girls.
Enuresis causes distress
to both the child and
his/her family.
The parents feel
frustrated, while the
children may suffer from
lower self-esteem and
social awkwardness
especially if wetting
occurs in a setting
outside of the home e.g.
friend’s sleepover.
The causes of primary
enuresis are
multi-factorial.
These include genetic
factors for there is
usually a positive
family history of
enuresis. In other
words, children whose
parent/parents had
enuresis are also more
likely to experience
enuresis. Other
factors include deep
sleepers, delayed
bladder maturation,
smaller functional
bladder capacity,
deficiency of
anti-diuretic hormone (ADH)
and constipation and/or
faecal incontinence.
More complex but rarer
causes include
congenital, structural
abnormalities of the
urinary system and/or
its innervation and
urinary tract
infections.
The triggers of
secondary enuresis
include medical and
emotional causes.
Medical conditions that
may manifest as enuresis
include diabetes
mellitus, urinary tract
infection, sleep apnoea
and constipation and/or
faecal incontinence i.e.
leak of feces.
Emotional stressors may
originate from diverse
sources e.g. parental
divorce, bereavement,
starting at a new school
and bullying.
The assessment of the
incontinent child
involves a detailed
history (from the
parents and the child)
and physical
examination. The
physical evaluation will
include an examination
of the abdomen, perineum
and sacral reflexes.
The basic investigations
include a urine analysis
and culture and also an
ultrasonography of the
kidneys and bladder.
Further investigations
are indicated in rare
cases and these may
include CT urogram, MRI
spine, urodynamics study
of bladder function and
cystoscopy.
Children with enuresis
can then be further
categorised into three
groups: nocturnal
enuresis only i.e.
bedwetting, diurnal
enuresis i.e. wet by day
and night and
complicated enuresis
i.e. incontinence
associated with
structural abnormalities
and/or infections.
The management of
nocturnal enuresis i.e.
bedwetting includes both
non-medical and medical
options. Simple,
non-medical, behavioural
modification is
important and effective.
Fluid management
involves encouraging
fluid intake during the
day and
decreasing/abstaining
from fluids two hours
before bed.
Voiding must take place
before sleep. In
addition, the practice
of waking the child
during the night to void
may help to condition
the child to avoid
wetting the bed.
Anti-diuretic hormone (ADH)
reduces urine production
by the kidneys. It
is normally produced in
increase amounts at
night (as compared to
the day) to reduce
nocturnal urine
production so as to
allow for a good night’s
sleep. This may be
deficient in bed-wetters
and treatment with ADH
analogues in addition to
behavioural therapy may
be necessary for some
children.
Another class of
medication that is
occasionally used are
the anti-cholinergic
agents. These
medications have the
effect of increasing
functional bladder
capacity thus allowing
the bladder to store a
bigger urine volume.
Other medical conditions
that are discovered
during the evaluation of
the enuretic child e.g.
diabetes mellitus,
urinary tract infection,
spinal cord
abnormalities, sleep
apnoea and problems of
bowel emptying must be
separately treated in
order to eliminate
bedwetting.
Although enuresis or
most commonly nocturnal
enuresis i.e. bedwetting
frustrates both the
parents and the affected
children, the prognosis
is good and expectant
management is adequate
in most cases.
Other effective means of
control include simple,
behavioural modification
with or without the aid
of medications.
Return
to Top
Article contributed by:
Dr Siow Woei Yun,
Specialist, Urology,
Raffles Hospital
for New Dimension -
biannual newsletter of
the
Society for Continence,
Singapore
Dated: April 2015
|
The
Society for
Continence,
Singapore
(SFCS) is a
non-profit
organization
that
originated
from the
dedicated
efforts of a
group of
doctors,
nurses and
rehabilitation
therapists
who
recognised
the special
needs of the
incontinent
as far back
as 1988.
The mission
of the
society is to
promote
bladder and
bowel health
and to work
towards a
community
free of the
stigma and
restrictions
of
incontinence.
The society
aims to
disseminate
information
and educate
healthcare
professionals
and the
public on
methods to
promote
urinary &
bowel
continence
and to
promote the
education,
training and
rehabilitation
of the
incontinent
and their
general
interests
and welfare. |
Back to
Table of Contents