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Bedwetting


Bedwetting or Enuresis is loss of urine during sleep which is a major problem for children. Bedwetting is never done on purpose or due to laziness on the child's part. It is involuntary urination by anyone over the age of five or six years when there are no medical or other causes. Majority of children learn bladder control between the ages of two and four. Bedwetting is a problem found more in boys than in girls. This is mainly due to a maturational delay in the development of bladder musculature and its ability to withstand the pressure of a large urine volume. If bed-wetting is still occurring at age of six or seven, you should consult a doctor.

Causes of Primary Enuresis/Bedwetting
Organic
    a) Bladder neck obstruction
b) Ectopic urethral opening
c) Epispadias
d) Sacral Agencies
e) Meningomyelocoele
f) Lipoma of the cauda equina
g) Rarely hydrocephalus, diabetes, mellitus, diabetes insipidus
Delayed maturation
Mental subnormality
Emotional deprivation
Causes of Secondary Enuresis/Bedwetting
Urinary tract obstruction
Emotional difficulties and stressful situations e.g.
    a) Illness
b) Birth of sibling
c) Death in a family
d) Chnage of school/house
Diabetes mellitus
Diabetes insipidus
Nocturnal seizures
Incidence of Nocturnal Enuresis/Bedwetting
18% at the age of 4 years
8% at the age of 8 years
5% at the age of 10 years
2% at the adolescence
The term 'Primary Nocturnal Enuresis' should be reserved for girls older than 5 years and boys older than 6 years.
Aetiological Factors In Primary Cocturnal Enuresis
Disorders of sleep and arousal
Small bladder size
Genetic predisposition-Familial tendency in which there is delayed maturation of CNS related to volitional control of micturation
Improper toilet training
School performance
Socioeconomic status(low)
Mental subnormality
Pathophysiology of Primary Nocturnal Enuresis
Primary nocturnal enuresis is a disorder of arousal. Most episodes of wetting begin in satge 4 sleep and are preceded by increase in muscle tone and body movements. The EEG shows bursts of delta waves and then a change to stage 2 or stage 1NREM sleep and voiding occirs. If the child be awakened at this point; the child reports no dreams and if allowed to go back to sleep, he wil have normal sleep pattern during the rest of the night. But if the child is not awakened and is left wet, the child will have no stage 3 or stage 4 sleep for several hours. If awakened later in REM sleep, he may report dreams about wetting (This explains the popular misconception that enuresis and dreaming are associated).