Bedwetting or Nocturnal Enuresis is a very common condition. Upto 10% children at the age of 5 and 5% children upto the age of 10 can bed wet. Some also have accidents during the day. If the child has never been dry, we call it ‘Primary Nocturnal Enuresis. If they have been dry and then start bedwetting again, it’s called Secondary NE. The causes of both can be different.
There are two main causes of bedwetting.
- Very dilute urine due to lack of a hormone called ADH (Anti diuretic hormone). Kidneys can’t concentrate the urine and thereby kids produce a lot od very dilute urine. There may be a rare condition called Diabetes Insipidus (different from Diabetes Mellitus, which can also sometimes lead to polyuria, which is excessive urination due to sugar in the urine), in which the body can’t just concentrate urine. Sometimes Desmopressin, which helps kidneys concentrate urine, helps.
- Bladder instability or hyper irritability. As soon as the urine reached bladder from kidneys via ureter, one needs to ‘GO’ as the bladder muscles (detrusor) starts contracting. These children have to rush, otherwise it comes out, day or night. Sometimes, a medicine called Oxybutanin, helps these children by just calming the bladder down.
- Usual strategies like plenty of water during the day, none after 6-7 pm, double voiding, avoiding constipation, bladder training at weekends, bedwetting alarms at night etc, should be tried.
We sometimes do an Ultrasound scan of the renal tract to rule out any structural abnormalities, though they are rare. We also have to rule out a urine infection and Diabetes Mellitus by checking the urine.
