Generally speaking, when children are 1 or 1.5 years old, they are able to control urination at night and bedwetting has been greatly reduced. However, some children are still only able to control urination during the day and still often wet the bed at night when they reach the age of 2 or even 2.5 years old, which is still a normal phenomenon. Most children stop wetting at night after the age of 3. However, if a child over the age of 3 is still wetting the bed more than twice a month, this is not normal. Bedwetting is medically known as “nocturnal enuresis” and “nocturnal enuresis”. Is bedwetting a disease? It sounds new, but it is not at all unusual.
Overview of the disease
There are primary and secondary forms of bedwetting in children. Primary enuresis in children, commonly known as bedwetting, is a condition in which urine is excreted in bed during sleep, without the person concerned being aware of it or in a dream, and only after waking up. Most of them are simple and persistent, i.e. there are no other accompanying symptoms except bedwetting, no organic lesions, and physical and chemical examinations are all in the normal range. The majority of bedwetters are primary. In 2-4% of children, enuresis may persist into adulthood. The danger of enuresis is a psychological disorder due to long-term damage to self-esteem.
Secondary enuresis can occur in children regardless of day or night, in bed or out of bed, awake or non-awake, and has other more obvious clinical symptoms and pathological manifestations besides bedwetting, mostly organic lesions such as lower urinary tract obstruction, cystitis, neurogenic bladder (neurological dysfunction), etc. It is mostly concomitant and transient and can improve with other lesions.
Generally, children start to control urination at the age of 3-4 years old, but if they still wet the bed regularly after the age of 5-6 years old, for example, twice a week or more for 6 months, it is medically called “enuresis”. Nocturnal enuresis is a common disease, and boys are more likely to suffer from this disease than girls in China. The exact cause of primary nocturnal enuresis is not known, but may be related to the following factors.
There are reasons for bedwetting in children
Genetic factors
Nocturnal enuresis usually runs dominantly in families. If both parents have been nocturnal enuresis sufferers, their children have a 3/4 chance of bedwetting. If one parent has been a bedwetter, there is a 1 in 2 chance that their child will have the condition.
Disease factors
Pinworms (irritation of the urethra by worms), urinary tract infections, kidney disorders, local inflammation of the urethra, spina bifida, spinal cord injury, sacral nerve dysfunction, epilepsy, cerebral insufficiency, small bladder volume, etc., but only a small percentage of bedwetting is caused by disease. The vast majority of bedwetting in children is related to mental factors, hygiene habits, environmental factors, etc.
Very deep sleep, unable to wake up in time to urinate
Some of the affected children are not trained to urinate, such as using diapers for a long time, parents do not wake their children at night and carry them to the toilet to urinate, or even some parents help their children urinate while they are lying in bed sleeping, resulting in the habit of urinating in their sleep. Over time, bedwetting is likely to occur at night.
Delayed development of nocturnal bladder control
Patients with nocturnal enuresis may improve their symptoms as they age and stop wetting the bed, but it may take years to stop nocturnal enuresis, and even 1% of people continue to wet the bed after they reach puberty.
Environmental factors
Sudden change of new environment; climate change such as cold, etc. In addition, children who drink too much water before going to bed; eat fruits with high water content and diuretic effect such as watermelon; parents who do not urinate in time when their children have the urge to defecate at night can cause bedwetting.
Insufficient production of ADH, the hormone that controls urination
In addition, 20-30% of children with nocturnal enuresis do not produce enough ADH, a hormone that is naturally produced by the body and reduces the amount of urine, during sleep.
Treatment measures for bedwetting in children
1.General treatment
Do not blame and scold the child, but give encouragement to make the affected child have the determination to cure bedwetting. Parents should give high care and love to the affected child. Forbid drinking water after dinner, put the child to urinate before bedtime, and wake the child up at night to urinate 1 to 2 times.
2.Drugs
①Promethazine: It is a central stimulant, which can reduce the depth of sleep. 25～50mg should be taken orally every night for 3～4 months. If relapse after stopping the drug, it can be given again. ② Parasympathetic blocker: Probenecid or oxybutynin (Oxybutynin, i.e., ditropan, uridorin). It is given orally before going to sleep to relax the detrusor muscle and inhibit bladder contraction. ③Ephedrine 25mg orally before bedtime. It can increase the contraction of the bladder neck and posterior urethra.
3.Bladder training
Ask the child to extend the interval of urination as much as possible during the day, gradually from once every 1/2 to 1 hour to once every 3 to 4 hours, in order to expand the bladder capacity.
4.Conditioned reflex training
Train the child to wake up before urination with a set of alarm device for urine loss. Once the electronic pad is wet, the electric bell will be connected to the circuit to wake the child up to urinate; if the effect is not good, promethazine can be added to reduce the depth of sleep. Generally, 70 to 80% of primary enuresis can be cured after 1 to 2 months of training.
5.Get children up to urinate every night
Because children have smaller bladders than adults, they need to urinate regularly to avoid bedwetting. If they get up at night to urinate, they basically won’t wet the bed, and pay attention to drinking less water after dinner.
Never scold a child who wets the bed
Bedwetting in children means that children over 5 years old cannot control their own urination and often wet their own bed at night and sometimes wet their pants during the day. The majority of bedwetting in children has nothing to do with illness, but is caused by psychological factors or various other factors.
Drink less water after 4 p.m. every day, eat less liquid for dinner, and do not eat fruits such as watermelon, oranges, raw pears and milk to reduce the amount of urine stored in the bladder at night. Don’t tease your child before bedtime, don’t let your child get excited, don’t let your child engage in strenuous activities, don’t watch thrilling and stressful movies and videos, so as not to overexcite your child.
Make it a habit to urinate thoroughly every day before bedtime to empty the bladder of urine. Grasp your child’s nighttime urination pattern and wake him up before he wets the bed to let him urinate.
It is important to note that bedwetting can make the affected child shy, anxious, fearful and cowering. If parents use scolding, threats and punishments, it will make the child more aggrieved and depressed and increase the psychological burden, and the symptoms will not be reduced but will be aggravated. We believe that treatment of children with enuresis should only be done with comfort and encouragement, which is very important and is a prerequisite for the success of treatment.
Small ways to treat bedwetting in children
Generally children are capable of not wetting the bed after the age of five, and those who still wet the bed after the age of five can be diagnosed as nocturnal enuresis. Generally, one tenth of children wet the bed at the age of five, and only one percent after 13, and boys grow and develop more slowly than girls, and wet the bed relatively more.
Less bedwetting in breastfed children
The clinical findings show that only 6% of bedwetting children are breastfed (more than three months), and some are not even breastfed at all, and the ratio of male to female bedwetting is 2:1.
Children who are breastfed have a good improvement in brain neurodevelopment and bladder stability and urinary tract sphincter, so breast milk is really beneficial in controlling bedwetting in children.