DR VIVEK REGE says bed wetting by children could be due to multiple reasons.
This is a common condition occurring in some children. Bed wetting a night during sleep in a child above the age of 5 years is considered abnormal and called Nocturnal Enuresis. Originally it was always thought that the cause is psychological but today it is known that there may be more than one reason for his anomaly.
There are two classification of this condition. The first is primary and secondary nocturnal. Primary nocturnal enuresis when the child has been bed wetting since younger days and continues to do so even after 5 years. Secondary nocturnal enuresis is when the child had stopped bedwetting for a continuous period of at least 6 months and again begins bed wetting. This is important for the possible cause and also the treatment of this condition.
The second classification has also two types one is Isolated/Monosymptomatic nocturnal enuresis-here the bed wetting is the only problem in micturition in the child. The other type is nocturnal enuresis with dysfunctional voiding symptoms here besides having bedwetting, the child has other daytime is in the cause and the therapy to be recommended for that particular child.
Why does a child have nocturnal enuresis? There may be multiple reason like-a small functional capacity of the urinary bladder-the amount of urine that a bladder can hold without discomfort of the child or the child having evacuate the bladder for relief; a delay in maturation of the development of the bladder growth, the nerves to and from the bladder, deep sleeper wit difficulty in arousing the child from sleep ,thus causing the child to pass urine in deep sleep unaware of the problem, abnormal intermittent contraction of the bladder, deep sleeper unaware of the problem, abnormal intermittent contraction of the bladder muscle causing evacuation of the bladder before it is full; or improper secretion of anti diuretic hormone in the body at night.
This hormone decreases the volume of urine excreted ay night, and less filling of the bladder and urine is passed out at night. There is a very strong hereditary role in transmission of the condition. There is a very high chance of occurrence in a child with both parents who were nocturnal enuretics, lesson in those with one parent and about 15 % in a child whose parents were normal too. Race may also have a role to play. Thus nocturnal enuresis is a mismatch between urine production and storage function. There may be one or more reasons for bedwetting in a given child and treatment becomes more diverse in such cases.
Such a child must be shown to a properly trained doctor if bed wetting continues beyond the age of 4 years. A detailed history and through examination followed by relevant investigation are a must to get the root cause of the condition. In some children a whole lot of investigations are required, in others very few need be done.