Definition
Bedwetting, or enuresis, is a childhood condition of urinating in bed while asleep at night. It is a chronic condition that often resolves by itself before the teenage years.
Description
One of the major tasks of toddlerhood is to learn how to achieve conscious control over the timing of urination. Most children do not become fully toilet trained until they are about two to four years old. Before then, the parts of the nervous system in charge of bladder control are not fully developed and functional. In general, boys take longer to learn to control their bladders than girls, and daytime bladder control is easier for a child than overnight bladder control. There is a genetic aspect to bedwetting, so that parents who once had the condition often have children who wet the bed at night.
Causes & Symptoms
Bedwetting is often due to the normal immaturity of the nervous system and the urinary system. For instance, up to age six, bedwetting is often due to nothing more than the bladder having a small capacity. In addition, the muscles that control the opening and closing of the urethra may not be sufficiently developed. Often it takes a while for a child learn recognition of bladder fullness, waking up, and going to the toilet. In most cases, urinary capacity and control increase over time, and the bedwetting problem will eventually be outgrown.
Surprisingly, a big cause of bedwetting is lack of sleep. If a child is not sleeping enough hours, then there will be less of the light, rapid eye movement (REM) sleep, and more periods of heavy, deep sleep. During the periods of deep sleep some children will have difficulty becoming aware of the urge to urinate and awakening to go to the toilet.
Bedwetting may be a sign of allergic reactions, which end up irritating sphincter muscles around the urethra. This contributes to a loss of bladder control during sleep. Heavy snoring, mouth breathing, and night sweats may all be indications of the presence of allergies.
Bedwetting can sometimes be due to emotional and psychological stress, including major life changes such as moving or a divorce. This usually leads to the type of bedwetting called secondary enuresis, in which a previous level of accomplishment with bladder control is lost. In other words, a child who has been dry at night will suddenly start wetting the bed again. This may indicate an underlying problem such as constipation, diabetes, physical defects in the urinary tract, sacral nerve disorders, a pelvic growth, urinary stasis, infection, kidney stones, or kidney damage. Secondary enuresis also frequently occurs in children who are being physically or sexually abused. A pediatrician should be consulted if the condition persists.
Only about 1% of bedwetting is caused by a serious underlying problem. If the following symptoms are present, a pediatrician or a pediatric urologist should be consulted:
- straining during urination
- a burning feeling or other discomfort during urination
- constant or recurrent dribbling of urine
- cloudy or pink urine
- bloodstains or other discharge on underpants or night-clothes
- an unpleasant urine odor
- onset of abdominal pain, backache, or fever
- constant thirst, especially at night
- sudden loss of bladder control previously mastered
- a child over the age of two who still shows no signs of being ready to learn bladder control
Diagnosis
When bedwetting is resistant to home treatments or when more serious symptoms are present, a visit should be made to a healthcare provider. This is especially warranted if the child is older than six. A thorough history and physical exam should be taken along with a urine sample. Analysis and culture tests can be done on the urine to determine if an infection is present. Further evaluations may be made using ultrasound, an x ray of the kidney, or a consultation with a urologist. If the bedwetting appears to be connected with issues of stress or family problems, a mental health consultation may be recommended.
Treatment
Sitting in a cool sitz bath (pelvic area only immersed) for about five minutes daily can tone up the urethral sphincter. This can be done using a bathtub filled with about two or three inches of water, having the child sit in a large basin of water or using a sitz basin (available from larger drugstores and medical supply stores).
"Hands-on" treatments such as acupressure, reflexology, and shiatsu can be used to relax the child, counteract stress, and improve the actions of the nervous system. Hypnotherapy can also be helpful in improving bedwetting. Among other things, the child will be given positive goal affirmations to say before going to bed.
This should help make the urge to urinate during the night more conscious, and therefore encourage the child to awaken and go to the toilet.
The best way to use homeopathy is o see a homeopath for individual prescribing. Equisetum 6c, may be useful, especially if there are dreams or nightmares connected with the bedwetting. For bedwetting in very excitable, outgoing children, which occurs soon after falling asleep, Causticum 6c may be recommended. The remedies should be given once per day at bedtime for up to two weeks. A practitioner should be consulted for more specific remedies.
Herbal Medicine
A strong tea can also be made using equal parts of horsetail, Equisetum arvense; St. John's wort; cornsilk, Zea mays; and lemon balm, Melissa offinalis. Two to three handfuls of the mixture should be placed in a quart or liter jar and then covered with boiling water. The tea should be allowed to steep overnight. The child should be given half a cup of the tea three times per day, with the last dose being given at least two hours before bedtime.
Nettles, Urtica dioica, can be made into a pleasant tea and consumed throughout the day as a tonic for the kidneys. The tea can be mixed with equal parts of fruit juice as a pleasant drink for the child.
Aromatherapy uses the essential oil of cypress, Cupressus sempervirens to treat chronic bedwetting. Several drops of cypress oil should be put in olive oil for massage. The oil should be rubbed onto the child's stomach right before bedtime.
Behavior modification programs may be suggested. In one type, alarms that are triggered by body moisture are worn overnight, waking the child at the first sign of bedwetting. The child can then go use the toilet to finish emptying the bladder. This will eventually train the child to awaken and use the toilet upon experiencing the sensation of a full bladder. Nighttime toilet training using the alarm may take up to four or five months to be effective, however. Another program uses the child's help with urinating before going to bed, recording wet and dry nights, changing wet clothing and bedding, and discussing progress. Positive reinforcements, such as gold stars on a chart and other rewards, are given for nights that the child does not urinate in bed.
Allopathic Treatment
If other treatments fail to work, treatment with medication may be suggested. With the use of the drug imipramine, improvement will usually occur in the first week of treatment if it is going to be helpful. The drug can be discontinued if it does not work within a week or after a month has gone by with no bedwetting. Unfortunately, relapses are very common with this treatment. Also, since imipramine is a strong drug, the blood needs to be tested every other week for abnormal side effects. A nasal spray containing Demopressin, an antidiuretic drug, has been shown to be effective in diminishing bedwetting. It is necessary to use the spray at least four to six weeks for maximum effectiveness. Demopressin also has negative side effects and is, therefore, only recommended for short-term use.
Expected Results
Bedwetting is usually outgrown at some point. However, underlying disease conditions may have to be assessed and treated.
Prevention
Caffeine has a diuretic effect, and should be avoided. It is found in coffee, chocolate, tea, and many sodas. Food labels should be examined to determine caffeine content.
Resources
Books
The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Virginia: Time-Life, Inc., 1996.
Kirchheimer, Sid and the editors of Prevention Magazine Health Books. The Doctors Book of Home Remedies II: Over 1,200 New Doctor-Tested Tips and Techniques Anyone Can Use to Heal Hundreds of Everyday Health Problems. Pennsylvania: Rodale Press, 1993.
Lockie, Dr. Andrew and Dr. Nicola Geddes. The Complete Guide to homeopathy: The principles and Practice of Treatment with a Comprehensive Range of Self-Help Remedies for Common Ailments. London: Dorling Kindersley, Ltd., 1995.
Other
AlternativeMedicine.com. http://www.alternativemedicine.com
American Academy of Pediatrics.
[Article by: Patience Paradox]
