Does your child also wet the bed at night? (Bedwetting) - Let's talk about this!

Are you worried about your child still wetting the bed at night, even though he or she is toilet trained? You may feel embarrassed, angry, or even helpless about this. But don't worry, this is a very common problem faced by many parents not only in Sri Lanka but all over the world. The most important thing is to understand that this is neither the child's fault nor your fault . Let's talk about this in detail .

What exactly is bedwetting?

Simply put, bedwetting, or medically known as ``Nocturnal Enuresis'', is the involuntary, uncontrollable leakage of urine during sleep at night. This is very common among young children.

Think about it, many children can still wet the bed at night after they are toilet trained, even up until the age of 4, 5, or 6. It's part of their body's development. It's because the communication between their bladder and brain isn't fully developed yet.

However, a doctor usually only starts to consider this a problem if the bedwetting continues more than twice a week after the age of 7 .

This is not a serious illness. However, it can cause psychological stress for the child and the family. The child may feel embarrassed and guilty in front of adults. Sometimes, they may even avoid things like staying at friends' houses or going on trips, out of fear of "What if I have to urinate at night?"

There are two main types of bedwetting.

We can look at this situation in two main ways. Understanding this will help you gain a better understanding of your child's situation.

Why does this happen to children (and some adults)?

There is no single reason for this. The reasons may vary from child to child and depending on age.

Why does this happen to young children?

In most cases, the main reason for bedwetting in young children is that they have not yet fully developed bladder control. This is normal. However, sometimes, especially if a child is a little older and continues to wet the bed, there may be an underlying medical condition.

• Urinary Tract Infection (UTI): Urinary tract infections cause frequent urination and difficulty controlling it.
• Constipation: When stool does not pass properly and fills the rectum, it puts pressure on the bladder. This can cause the bladder to not have enough room to fill completely or cause loss of control.
• Diabetes: This can be an early symptom of diabetes. When the body's sugar levels increase, more urine is produced.
• Problems like snoring (Obstructive Sleep Apnea): Children who have difficulty breathing during sleep may have changes in the function of certain hormones in the brain, causing them to produce more urine at night.
• Nerve Problems: If there is any weakness in the nerves that carry messages from the bladder to the brain.
• Conditions such as ADHD: This condition is also common in children with attention and performance problems.

Causes affecting adults and young children

If an older person has this condition, it may be due to the following reasons.

• Genetics: If your mother or father had this problem as a child, your child is more likely to have it too.
• Hormones: Our body has a hormone that reduces urine production at night. It is called `(Vasopressin)`. Some people's bodies do not produce enough of this hormone at night. Then they produce urine at night as well as during the day, and the bladder fills up quickly.
• Small Functional Bladder Capacity: In this case, the bladder is normal in size, but even when slightly full, it sends the wrong signal to the brain, saying "It's full now, I need to urinate ."
• Deep Sleep (Failure to Awaken): Some children (and adults) sleep so deeply that even when their bladder is full and signals are sent to the brain, they do not wake up.
• Psychological Problems: Imagine, things like losing a family member, moving to a new school, parental issues, or exam stress can cause a child who has been doing well for months to start wetting the bed again.

When should we see a doctor?

Although bedwetting is normal, sometimes it is important to seek medical advice. It can also help to alleviate your fears and doubts.

How to treat and manage?

The best thing is that there are very effective treatments and management options for this. Your doctor will examine your child, ask you about your symptoms, and if necessary, perform a urine test, to determine the best treatment for your child.

1. Behavioral Changes

These methods are often tried first. They help solve the problem without resorting to medication.

• Limit fluids before bed: Stop giving water, milk, and soft drinks about 2 hours before bed. However, you should give your child plenty of fluids during the day.
• Make sure to go to the toilet before bed: Even if your child says they don't have a urinary tract infection, make it a habit to go to the toilet and empty their bladder completely before bed.
• Enuresis Alarm: This is a small device. A sensor is attached to the child's underwear. When a drop of urine is passed, the sensor detects it and an alarm (sound or vibration) is activated. This wakes the child up. Over time, the brain gets used to waking up when the bladder is full. This is a very effective method.
• Bladder Therapy: During the day, when the child needs to urinate , they are taught to hold it for a few minutes. This time is gradually increased. This trains the bladder to hold more urine. This should be done under the advice of a doctor.

2. Medications

If the above methods are not effective or if there is another medical reason, your doctor may prescribe medication.

• Desmopressin: This is a synthetic drug similar to the hormone `(Vasopressin)` we discussed earlier. It works by reducing the amount of urine produced at night.
• Oxybutynin or Tolterodine: These medications help reduce bladder contractions if you have an overactive bladder.

The most important thing is to shape the child's mind.

Even more important than treatment, and perhaps even more important, is providing emotional support to the child. This can have a huge impact on the child's self-confidence.

• Never scold your child: Do not scold, punish, or shame your child in front of others for wetting the bed. This will only make the problem worse.
• Explain that this is not his/her fault: Tell the child lovingly, "This is not your fault, son/daughter. This will go away on its own when you grow up. Let's work this out together."
• Involve your child in changing the bed sheets: Don't use this as a punishment, but as a responsibility, saying, "Let's both clean this up together."
• Celebrate "Dry Nights": Give your child a small gift for the days they don't wet the bed at night, or put a star on a calendar. Little things like this can be a big encouragement to your child.

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