Dear Doctor,                

My son is in P.7 and still wets his bed. He does this regularly. What bothers me is that sometimes, he wets his bed even when he has just slept. Is there any medication for this problem?

Worried Parent

Dear Parent

I can indeed understand your anxiety. Bed wetting or nocturnal enuresis is not acceptable socially after infancy. Hence it becomes embarrassing for the individual as well as family members. Moreover dampness makes one susceptible to infections. However it is not clear whether this child has continued bed wetting or he had gained bladder control and become incontinent recently.

Bed wetting is the most common urological problem in children. Bed wetting in most children occurs simply due to delay in complete control of bladder. During day time the child consciously pays attention to needs of his bladder but when deep in play or sleep, he tends to ignore it. The child may be absolutely normal for his age but the neurological perception of a full bladder may be delayed to develop thus resulting in bed wetting. Some children may have delayed development mile stones or may have impaired development, which has bed wetting as one of the manifestations. Hormonal disorders as that of anti diuretic hormone produces excess urination in night, which can cause bed wetting. Children who sleep walk tend to pass urine in bed, because mentally they think they are in another room. It has a strong genetic component also. If one or more of the parents have been bed wetting as children, the risk increases in a child by 44 to 77%. Stress is known to result in bed wetting in children. It has been seen in children of divorced parents.

Bladder infections cause frequency and urgency of urination, which may lead to passing urine in bed at night. In rare cases it may be due to congenital abnormalities of the urethra or bladder. Allergies are known to cause bed wetting but how the link is yet not established.

Drinking more water, drinking alcohol or caffeine at bed time can also result in bed wetting due to excess urination.

Majority of the children do outgrow bed wetting. It is advisable to avoid giving any liquids at least 2 hours before bed time. He should be compulsorily made to pass urine before going to bed. After mid night, he should be woken once and taken to the toilette at a fixed time daily. This helps in training of bladder and gradually the child learns to pass urine only when standing in the toilette.

Drugs like imipramine also help in controlling nocturnal enuresis. Bladder infection or any other medical condition  can be diagnosed and treated. Congenital abnormalities causing bed wetting can be corrected surgically.

The child needs complete emotional and physical support of his parents. He should never be ridiculed for this problem as that would tend to aggravate the problem and delay treatment.