Dear Doctor,

My 9-year-old daughter still wets the bed and I feel like she should have stopped by now. I do not give her anything to drink just before bed because I’m told that it will worsen the problem. But she still wets the bed almost every night. I even try waking her up every two or three hours to use the bathroom but somehow, that doesn’t help. How can I get her to stop? Is this normal?

Carol

Dear Carol,

Bedwettingis a problem for the child affected as well as the parents and family. But it is not uncommon. As per statistics, 15 per cent of children older than five years wet their bed in the night, either daily or occasionally. But it is a problem, rarely disclosed outside the house.

A toddler indulges in bedwetting, because the centre for control of bladder in the brain is not yet developed. As a child grows older, this centre is developed and better coordination develops between brain and the bladder. However, this period is variable and varies from two to three years or even till an older age.

In 90 per cent cases, the problem is genetic. If one of the parents or any sibling or blood relative has been wetting the bed in the night, a child in the same or next generation is sure to be affected. Children may sometimes pass urine in the bed, if sleep is very profound. An older child can pass urine in their sleep if bed clothes/night clothes are damp or weather is very cold. Stress is also said to be one of the factors responsible for a child being incontinent in the night while sleeping. Fights in the family, recent divorce of parents, problems in school, etcetera, can induce stress in a child, which may manifest as bedwetting. Being ridiculed by other family members for the same makes it worse. 

Inadequate quantity of ADH (anti diuretic hormone- which reduces the amount of urine formed), also leads to bedwetting in a child. Urinary tract infections, worm infestation, spinal injuries or diseases, congenital bladder abnormalities, small size of urinary bladder, and uncontrolled diabetes are some medical problems which can lead to bedwetting.

Bedwetting makes a child susceptible to infections. It also reduces self-esteem. Hence, it is important to correct it. Avoid giving fluids to the child at least two hours before bed time. See that clothes worn or used by the child for sleeping are dry and the room is warm. Try waking her at a fixed time every night after she sleeps. Then take her to the toilet and let her wait there few minutes, till she passes urine. This way, the bladder will be trained to empty at a fixed time, thus minimising the risk of the bed being spoilt.

Never criticise or mock a child for bedwetting. Always be supportive. Gradually, as her self-confidence improves, she herself will make efforts to avoid it. 

In case of any doubt regarding any underlying medical problem, it is advisable to get suitable investigations done and take proper treatment.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk