Bed wetting is normal till age 5 after which it is termed as ‘Nocturnal Enuresis’. There are about 15% of children suffering with this issue by age 5, 7% by age 10 and around 2% of pubertal children with long term issues.
While it may appear as a subtle and private problem for a child, it can often be very disruptive in their daily life style and hinder their developing self-esteem. It can sometimes lead to long term social/psychological issues if not timely managed.
Why does it happen?
It mostly occurs due to a lack of synergy between bladder and brain, but sometimes it can be due to lack of a hormone called Vasopressin which is required to suppress urine production at night, and less commonly due to an overactive bladder which is often combined with daytime problems as well.
It can often present as a ‘secondary ‘problem after any insult to bladder ie urinary tract infections, wrong voiding pattern, or even due to disruption in their social life. Very rarely it can be secondary to a neurological problem.
How is it diagnosed?
The diagnosis is mostly based on good history taking and physical examination, only in selected cases there may be need of further investigations with Ultrasound for Kidneys/Bladder or bladder voiding studies to assess the structure and function of bladder.
How can I help?
I have a special interest and a wealth of experience in childhood kidney/bladder problems and I have successfully initiated and led special clinics for Enuresis at various NHS hospitals since 2005. I have been working with GPs and school health nursing teams for management of their patients, as well as guiding and educating the health professionals.
Once a referral is received from your GP/SHN, I shall organise for a mutually convenient appointment with you and your child face to face at Spire Health Care Centre. I will go through a detailed history in a friendly and non-challenging environment and establish a management plan based on the individual needs of your child.
Most of the children coming to my clinic do not need any special investigations, however we can organise for an ultrasound of kidney at the site if required. A very small fraction of children may need a voiding study, this is non-invasive and only includes the child voiding on a special toilet attached with a monitor, which would be organised at a different site in a private setting.
While my initial choice of management always rests on behaviour modification, developing self-motivation and self-esteem, often children may need medications for short to medium term use especially if the initial measures have failed to produce a response. The choice of treatment is carefully selected based on the history and diagnosis in liaison with parents and children’s choices, and all the medications used are very safe with minimal side-effects.
I also provide useful tips and guidance to you to help your child and also signpost to useful self-help websites.
Your GP/SHN would be constantly involved in sharing the management plan during your journey at care with me.
What should you do to prevent/improve?
A regular liquid take and bladder habit is very important to synergise the bladder functions. Your child should be encouraged to drink at least 6-8 classes of clear liquid per day, and empty their bladder regularly during day time. School Health nurses can often provide guidance and help towards this.
Many parents try to lift their child a few hours after going to bed. This is not recommended and can be more disruptive to the child’s sleep. Stopping drinks a few hours before bed, and going to the toilet with good perineal hygiene does help.
While it is a common problem in young children with a good outlook if managed in a timely manner, it needs to be addressed as soon as possible to avoid the chronicity and psychological effects on child’s development and socialisation needs. It is recommended to manage the condition by 7 years of age after which the long term outlook can be slightly concerning.