Nocturnal enuresis- bedwetting
Nocturnal enuresis – also called bedwetting. is involuntary urination while sleeping after the age at which staying dry at night can be reasonably expected.
Generally, bed-wetting before age 7 is not a concern. At this age, your child may still be developing nighttime bladder control.
Enuresis can happen during the day or night. As it can be a frustrating condition, still important to be a parent to remember that it’s not your child’s fault.
There are four types of nocturnal enuresis- bedwetting. A child may have one or more of these types-
1. Nighttime (nocturnal) enuresis-
This is the most common type of enuresis. It simply means wetting during the night. Oftenly it is called bedwetting.
2. Daytime (diurnal) enuresis-
This is wetting during the daytime.
3. Primary enuresis-
This type of wetting happens when a child has not fully mastered toilet training.
4. Secondary enuresis-
This happens when a child once comes in a period of dryness, unfortunately then returns to have periods of wetting.
Most kids are fully toilet trained by age 5, but there’s no targeted date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still make the bed wet.
The main symptoms of enuresis include-
1. Repeated bed-wetting
2. Wetting in the clothes
3. Wetting at least twice a week for approximately 3 months
What happens in nocturnal enuresis –
The bladder is a muscular receptacle, or holding container, for urine. It expands as pee enters and then contracts to push the urine out.
In a person with normal bladder control –
a. Nerves in the bladder wall send a message to the brain when the bladder is full.
b. The brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom.
But people with nocturnal enuresis have a problem in this process that causes them to urinate involuntarily at night.
No one knows the exact cause of nocturnal enuresis. Nevertheless, the following cause is thought to cause this problem-
a. Hormonal problems-
A hormone called antidiuretic hormone or ADH, causes the body to make less urinate at night. But some people’s bodies don’t make enough ADH, which means their bodies may make too much urine which they are sleeping.
b. Bladder problems-
In people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine.
c. Sleep apnea-
Sometimes bedwetting is a sign of obstructive sleep apnea. A condition in which the child’s breathing is interrupted during sleep.It happens often due to inflamed or enlarged tonsils or adenoids.
d. Caffeine –
Using caffeine causes a person to urinate more than normal.
e. Medical conditions-
Medical conditions that can trigger secondary enuresis include diabetes, urinary tract abnormalities, constipation, and urinary tract infections (UTIs).
f. A small bladder-
If your child’s bladder did not develop enough to hold urine produced during the night, then also bedwetting happens.
Risk Factors –
Nocturnal enuresis-Bedwetting can affect anyone. It is twice more common in boys as in girls. The following factors are associated with increased risk of bedwetting –
1. Stress and anxiety –
Stressful events- Such as becoming a big brother or sister, starting a new school, or sleeping away from mom – may trigger bed-wetting.
2. Family history –
If one or both of a child’s parents wet the bed as children, their child has a significant chance of wetting the bed, too.
3. Attention-deficit/ hyperactivity disorder (ADHD)-
Bedwetting is more common in children who have ADHD.
Although frustrating, nocturnal enuresis -bedwetting without a physical cause doesn’t make any health risks. However, bedwetting can create some issues for your child, which are as follows –
1. Guilt and embarrassment, which can lead to low self-esteem
2. Loss of opportunities for social activities, such as sleepovers and camp
3. Rashes on the child’s bottom and genital area – especially if your child sleeps in wet underwear.
Depending on the circumstances, the following steps can be taken to diagnose the problem.It helps in determining treatment.
1. Physical Examination
2. Discussion of all the points starting from symptoms to family history
3. Urine tests to check for signs of an infection or diabetes
4. X-rays or other imaging tests of the kidneys or bladder to look at the structure of the urinary tract
Most children outgrow bedwetting on their own.
If your child isn’t especially bothered or embarrassed by an occasional wet night lifestyle changes works. uch as avoiding caffeine entirely and limiting fluid intake in the evening- may work well.
Options for treating bedwetting may include moisture alarms and medication.
These are small, battery-operated devices. Moisture alarms need to be connected to a moisture-sensitive pad on your child’s pajamas or bedding. When the pad senses wetness, the alarm goes off.
Certain types of medication which can help in bedwetting are –
• Slow nighttime urine production-
The drug desmopressin reduces urine production at night. Drinking too much liquid with the medication can cause problems.
• Calm the bladder-
If your child has a small bladder, an anticholinergic drug such as oxybutynin may help reduce bladder contractions and inquire bladder capacity, especially if daytime wetting did.
Lifestyle changes which need to be adopted for correcting the bedwetting problem-
a. Limit fluids in the evening
b. Avoid beverages and foods with caffeine
c. Encourage double voiding before bed
d. Encourage replay toilet use thong front the day
Ayurvedic Perspective –
The process of urine formation is aided by Prana, Vyana & Apana vata and Avalambaka kapha with the overall control of mind.
Urination is one of the functions of normal Apana vata. The activities of Apana vata are regulated by prana and vyana vata.Prana has an overall control over the organs of sense and mind.
The Apana facilitates active excretion of urine, motion, semen etc.After attaining a level of developmental maturity, there develops a control over these activities initiated by Prana and vyana.
But in this condition the overall control of the activities of Apana is not developed. It results in vitiation of Apana which in turn result in loss of control of micturition.
The vitiation may also be due to encircling of Apana by Kapha which accelerates the exception of urine.
In Ayurveda it is known as Shayyamutra
2. Vishatinduka –
4. Amla –
5. Kataka –
Ayurvedic Medications –
1. Krimikuthar Ras
2. Vishtiutudak Vati
3. Chandraprabha Vati
1 pinch (100 mg) of turmeric and 2 pinch of (200 mg) of Amla (gooseberry) powder are taken together and administered along with honey twice a day. This checks the complaint of bed wetting effectively.
Bimbi (Coccine fruit – Coccinia indica) fresh root is obtained and the fresh juice is collected. 2-3 ml of this is mixed with 3-4 ml of honey and administered to the children. But care should be taken so that excess administration may cause vomiting in the children
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