Nocturnal enuresis, commonly called bedwetting, is unintentional passing of urine while asleep after the age at which bladder control usually occurs. Bed wetting of children may be simply a delay in the establishment of voluntary control over the act of micturition
It is the most common childhood urologic complaint and one of the most common pediatric-health problems. Most bedwetting, however, is just a developmental delay. It not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.
Most girls can stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%.
Why are you not wetting your bed at night?
There are two physiological functions that prevent bed wetting at night. First one is an antidiuretic hormone called arginine vasopressin which reduces urine production at night. Second one is the ability to wake up when the bladder is full. The first one will not be there at birth. Many children develop it between the ages of two and six years old, others between six and the end of puberty.
The typical development process begins with one- and two-year-old children developing larger bladders and beginning to sense bladder fullness. Two- and three-year-old children begin to stay dry during the day. Four- and five-year-olds develop an adult pattern of urinary control and begin to stay dry at night.
Types of nocturnal enuresis.
There are two types
1) Primary NE:- In this the child never has been dry.
2) Secondary NE:- Secondary enuresis occurs after a patient goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection
What cause Bed wetting?
There are many reasons for Bed wetting. Some of them are as follows.
· Neurological-developmental delay: - Most bedwetting children are simply delayed in developing the ability to stay dry and have no other developmental issues.
· Genetics :- Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.
· Caffeine:- it can increase urine production
· Alcohol conception
· Physical abnormalities:- Less than 10% of enuretics have urinary tract abnormalities, such as a smaller than normal bladder.
· Infection/disease:- these are more strongly connected with secondary nocturnal enuresis and with daytime wetting.
· Stress:- It is not a cause for primary NE. It is mostly associated with Secondary NE
· Traumatic: - After circumcision operation or Catheterization. It comes in Secondary NE
· Worms can a reason for NE
· Bad toilet training , some bad home situations and problems at school can cause NE.
· Its been said that it is a kind of habit. It’s been found a sudden stopping of NE after marriage in girls.
Symptoms and signs associated with NE.
§ Frequency of urination
§ Urgency
§ Burning on urination
§ Discolored urine
§ Unable to control defecation
§ Constipation
The main symptom will be wetting of bed at night even after age of bladder control.
The above symptoms are mostly seen In secondary NE.
How to Diagnose the situation?
A careful history should be obtained and a thorough physical examination should be performed to look for causes of Nocternal enuresis in children who present with bed-wetting. Causes of complicated enuresis include urinary tract infection, spinal cord abnormalities with associated neurogenic bladder, posterior urethral valves in boys, and ectopic ureter in girls. In addition, a bowel history is needed to rule out chronic constipation.
Parents should be questioned about their family history and the child's medical history . Careful questioning of parents and children can be extremely helpful in determining the type of enuresis and a possible cause or contributing factors.
What should Parents do?
Parents often are not fully aware of their child's daily voiding habits. Thus, a voiding diary may need to be maintained for a week or more. The family should keep track of how many times the child voids during the day and how many nights the child wets the bed.
Follow the things given below and feel happy with your kid.
- Limit drinks after dinner, and keep caffeinated beverages to a minimum all day (they irritate the bladder and make the kidneys produce more liquid).
- Start the habit of using the bathroom right before bed.
- Explain that it's okay to get up during the night to go to the bathroom. (And leave a nightlight on in there.)
- Consider stationing a portable potty (and a nightlight) in your child's bedroom.
- Don't wake your child to use the potty before you turn in -- it won't teach him to get up on his own.
- Never push him, shame him, or make him sleep in a soggy bed. It could have the opposite effect, causing daytime accidents and lowering self-esteem.
- Offer simple gift -- a sticker, say, and words of praise -- when there's a dry night.
- Expect accidents. Retire the diapers once your child's able to stay dry five nights in a row (it's fine to bring them back out if his streak doesn't last), but don't take the plastic cover off the mattress for another year or so.
Homeopathy for Bed wetting
It is a normal thing till the age 2 to 4. As it is hereditary sometimes, a detailed history is needed for a homeopathic prescription. After figuring The mental and physical generals of the child a constitutional remedy is prescribed by a homeopath. In my experience I have found good improvement in my patients.
I am listing out a group of medicines which can be prescribed for NE
Belladonna:Children with blue eyes , light hair , fine complexion ,delicate skin, restless sleep, involuntary urination consequent upon paralysis of sphincter muscles. This patient has fear of Dogs, cats and dark animals.
Rhus tox: Enuresis due to weakness of bladder with constant dribbling of urine. Weak muscular tone.
Causticum:Particularly in children during first sleep worse in winter and ceases or becomes more moderate in summer with great debility . Incontinence of urine. Urinates while coughing.
Gelsemium:Due to paralysis of sphincter muscles , does not like to talk with anybody .
Petroleum:Due to weakness of bladder, urine drops out even after urination, involuntary at night in bed.
Sulphur: wetting bed at night, copious discharge of children who suffer from chronic cutaneous eruption. Irritable hot intelligent children with a untidy skin and red lips.
Kreosotum:Enuresis with dream of urination in a decent manner, wets the bed at night. Very offensive urine with yellowish discoloration.
Borax : Frequent urination at night, children who are frightened when being laid in a cot or carried down stairs. Useful in hot patients.
Argentum nitricum: Great nervousness with restlessness, urine passes unconsciously and interruptedly, pale fetid urine, drinking coffee aggravates. The child has fear of streets and buildings.
Psorinum:Worse during full moon. Intractable cases, when there is an eczematous history. In children when there are Psoric manifestations. Secretions have filthy smell. The child is very sensitive to cold.
Calcarea carb : complaints of children who are fat, fair and flabby too much emission of urination at night. Sour vomiting of children during dentition with a tendency to eat indigestible things such as chalk, pencils etc, Timidity and slowness of all motions will be seen in this.
Medorrhinum : in children where there is a psychotic history nocturnal enuresis weak memory, fear in the dark as if some one is behind her/him.
Sepia : The sepia child is dull, depressed moody indolent with a greasy skin disinterested in work worse from change of weather. A tendency to diarrhea from boiled mil, the child is prone to enuresis during the first sleep.
Cina: the chief remedy for worms. The child is very irritable useful for round and thread worms (not pin worms) urine turns milky on standing. Enuresis during first sleep, great appetite soon after leaving the table.
Silica : useful for children suffering from worms due to weakness of urinary organs . Obstinate children.
Tuberculinum : Enuresis in a child with primary tuberculosis psychotic persons.
Pulsatilla—suited to cases of nocturnal enuresis occurring in children of tearful habit, conscious of its leakage but unable to control it. The urine passed drop by drop. Mild yielding girls who cries very easily. Intolerance to fatty foods.
Pulsatilla—suited to cases of nocturnal enuresis occurring in children of tearful habit, conscious of its leakage but unable to control it. The urine passed drop by drop. Mild yielding girls who cries very easily. Intolerance to fatty foods.
Equisetum : Enuresis by day and night, it acts well when it remains a mere force of habit, after removal of the primary cause, dreams of seeing crowd of people
Kali phos : Enuresis in longer children due to nervous factors.
Kali brom : Nocturnal enuresis from profound sleep of children or young persons.
Benzoic acid: when enuresis is accompanied by high colored and strong smelling urine, Benzoic acid will turn the urine normal and prevent its escape.
Nat. mur : Hungry yet looses flesh , craving for salt , aversion to bread and fats , child emaciating from neck urine passing involuntarily when walking and coughing , has to weight a long time for it to pass if others are present . Bed wetting in school going girls. Hot patient with craving to salt.
Capsicum:has never recovered from a house move or other displacement.
I have not listed all possible medicines for bed wetting here. A homeopathic medicine shout be figured after the complete canalization of the case.
Sources:
www.Aafp.org
www.Parenting.com
www.Wikipedia.org
ww.Madeformums.com
www.parentsask.com
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