Bed wetting (enuresis) is a medical problem that makes businessmen dread overnight trips to a conference, causes marriages to break up, stops teenagers from spending the night at a friend’s, and drives the mothers of some children to desperation.
Normally, urine is retained in the bladder by the contraction of a ring shaped bundle of muscle that surrounds the bladder opening. When one wishes to pass urine, this ring of muscle relaxes, and the muscles in the wall of the bladder and around the abdominal cavity, contract to squirt the urine out in a steady stream.
Those who are bed wetters, tend to sleep very deeply, and during the deepest phases of this sleep, when all the main muscles of the body are totally relaxed, the sphincter ring muscle that retains the urine in the bladder, also relaxes. Because there is no associated contraction of the muscles in the bladder wall or elsewhere, the urine just dribbles out slowly in the night, not in a hard stream.
Many children may be three or four years old before bladder control is obtained.
The first step is to investigate the patient to exclude any cause for bed wetting. Chronic urine infections, structural abnormalities of the bladder, and other rarer conditions may cause a weakness or excessive irritability of the bladder. These problems must be excluded by urine tests and x-rays.
In children lifestyle stresses (eg: family break up, moving home, hospital admission), social pressures (eg: poverty, overcrowding, lack of privacy) and excessively strict toilet training may cause psychological barriers to bladder control. An intellectual disability may make it impossible for a child to learn the reasons for bladder control.
Other uncommon possible causes include diabetes mellitus (lack of insulin production in the pancreas), epilepsy, paraplegia, spina bifida or a fracture of the pelvis.
A number of very rare brain disorders may also cause bed-wetting (enuresis).
There are several steps in any treatment regime for this condition, but do not start before five years of age. They include:-
- restrict fluids for three hours before bedtime, take child to the toilet during the night, and establish a reward system for dry nights.
- a bed-wetting alarm that consists of a moisture-sensitive pad that is placed under the patient, a battery and an alarm. When it becomes wet from the first small dribble of urine, it sounds the alarm, the patient is woken, and can empty the bladder before returning to sleep. After a few weeks use, most people learn to waken before the alarm.
- amitriptyline (Tryptanol) is taken every night to alter the type of sleep. Over a few weeks, the dosage is slowly lowered and hopefully, the bad sleep habits and bed-wetting do not return.
- desmopressin nasal spray or tablets at bed time acts on the pituitary gland in the brain, and this instructs the kidney to reduce the amount of urine produced during the night.
- psychotherapy in the most resistant cases.
Please remember that premature treatment can cause permanent sleep disturbances in a child, but there are no serious long-term medical consequences from bed wetting.