Dear Doctor, My daughter is 14 years old and she still wets the bed from time to time. Is there something wrong with her bladder? What can you recommend to stop this? Abby

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Dear Abby,

Bedwetting or nocturnal enuresis in a 14-year-old child is indeed worrisome. But it can be due to multiple causes and can be corrected. Though it is embarrassing, the parents should realise that the child is doing so involuntarily, hence, should never be criticised or reprimanded for it.

An adolescent girl can have nocturnal enuresis due to bladder infection, that is, cystitis. Here, due to inflammation of the inner lining of the bladder and resultant irritation, there is frequency of urination along with urgency to pass urine. In sleep, this can make one incontinent. A small sized bladder can hold only a small amount of urine and urine would dribble out, after it is full. Bedwetting can occur due to drinking more fluids, particularly in the evening before sleeping. It can be due to pinworm infestation.

Bedwetting is also a manifestation of damage to the nervous system or spinal cord, as in diabetes or injuries or infections of the spinal cord. Due to chronic constipation, the laden bowels can press upon the urinary bladder, causing urgency of urination. During sleep, it can cause incontinence and bed wetting.

An adolescent may simply avoid going to the toilet before sleeping and a full bladder can be emptied on the bed in deep sleep. Snoring during sleep can lead to bedwetting.  It can be due to something bothering the child or due to depression. Apart from these reasons, hereditary factors also play a part.

It is advisable to restrict the fluid intake of your daughter, in the evening, particularly two hours before bedtime. 

Wake her up at a fixed time each night after she sleeps and make her empty her bladder in the washroom. This will condition the bladder, such that it will know to ‘empty’ at a fixed time, thus, bedwetting can be avoided. Treatment depends on the underlying cause, if clearly identified. Medications are available to help keep the child dry in the night.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital