Treating Incontinence

Treating Incontinence

Bed wetting is nobody’s fault. Understanding and compassion can help children and adults outgrow this habit
By Dr S P Yadav

Bedwetting is a normal developmental stage for children, but it can be a symptom of underlying illness or disease in adults. About two percent of adults suffer from bedwetting.Physical and psychological conditions can lead to bedwetting in some people.
Bedwetting is an issue that millions of families face every night. It refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence.
It is extremely common among young kids but can last into teen years. Bedwetting is the loss of bladder control during the night. The medical term for bedwetting is nocturnal (night time) enuresis. Bedwetting can be an embarrassing issue, but in many cases, it is perfectly normal.
Common causes of bedwetting among children and adults include small bladder size, urinary tract infection, stress, fear, or insecurity, neurological disorders, diabetes, prostate gland enlargement, sleep apnea (abnormal pauses in breathing during sleep) and constipation. The hormonal imbalances can also cause bedwetting in some people. Human body makes a hormone called antidiuretic hormone (ADH). The ADH tells your body to slow down the production of urine overnight. The lower volume of urine helps normal bladder hold urine overnight. People whose bodies don’t make sufficient levels of ADH may experience nocturnal enuresis because their bladders can’t hold higher volumes of urine.
Diabetes is another disorder that can cause bedwetting. The bodies of people with diabetes don’t process glucose (sugar) properly and may produce larger amounts of urine. The increase in urine production can cause children and adults who normally stay dry overnight to wet the bed.
Gender and genetics are among the risk factors for bedwetting. Both boys and girls may experience episodes of nocturnal enuresis during early childhood. Boys are more likely to wet the bed when they get older.
Family history plays a role, too. You’re more likely to wet the bed if a parent, sibling, or other family member has had the same issue.
Bedwetting is also more common among children diagnosed with attention deficit hyperactivity disorder (ADHD). Researchers don’t yet fully understand the relationship between bedwetting and ADHD.
Certain lifestyle changes may help end bedwetting. Setting limits on fluid intake plays a large part in controlling bedwetting. Try not to drink water or other liquids within a few hours of bedtime to reduce the risk of having an accident. Drink the majority of your daily fluid requirements before dinner time. This will ensure that your bladder is relatively empty before bedtime.
You should also cut out caffeinated or alcoholic drinks in the evening. Caffeine and alcohol are bladder irritants and diuretics. That means they’ll cause you to urinate more.
Devise a voiding schedule to help you stay dry overnight. A voiding schedule simply means that you urinate on a regular timetable, like every 1 to 2 hours. Use the bathroom right before you go to bed to empty your bladder fully before sleep.
Bedwetting can sometimes occur during a stressful event in a young person’s life. Conflict at home or school may cause your child to have nightly accidents. The birth of a sibling, moving to a new home, or another change in routine can be stressful to children and may trigger bedwetting incidents.
Understanding and compassion can help your child feel better about their situation, which can put an end to bedwetting in many cases.Refrain from punishing bedwetting incidents. Praise your child when they stay dry. This will help them feel good about not wetting the bed.
The brain and bladder gradually learn to communicate with each other during sleep, and this takes longer to happen in some kids.Low anti-diuretic hormone (ADH) tells the kidneys to make less urine. Studies show that some kids who wet the bed release less of this hormone while asleep. More urine can mean more bedwetting.
Deep sleepers families have been telling for years that their children who wet the bed sleep more deeply than their kids that don’t. Some of thesechildren sleep so deeply, their brain doesn’t get the signal that their bladder is full.
Although a child’s true bladder size may be normal, during sleep, it sends the signal earlier that it’s full. Full bowels press on the bladder, and can cause uncontrolled bladder contractions, during waking or sleep.
Medical causes of bedwetting are nearly always uncovered by simply talking to a child and her parents, performing an exam, and testing the urine. Being alert to urinary symptoms can ensure that if there is a problem, your child will get the treatment he needs. Most urinary problems are easily fixedif identified early.
Sometimes your child suddenly needs to urinate more frequently (every five minutes, say) but produces only a small amount of urine each time. Frequent urination is accompanied by pain, fever, or foul smell. The girls get more infections. This is because the opening of the urethra, the tube leading from the bladder to the outside, is short and close to the anus. Bacteria can easily enter thebladder. There are some precautions you can take to minimize the risk of a urinary infection. Wipe your daughter from front to back, and teach her to do it this way.
Avoid bubble bath, which can enter and irritate the bladder and prepare the way for an infection. Make sure girls drink water or other liquids frequently. Girls should have to urinate every two to four hours during the day, and their urine should be very clear if they are drinking enough fluid.
Watch your child’s urine stream, especially if you have a boy. A nice, strong flow that arcs well away from the body is normal in boys. A weak, dribbling stream, or the constant release of small amounts of urine that leave underwear or diapers perpetually damp, can signal an abnormality of the urinary tract. If a child has to strain to urinate or has a hard time starting, let your healthcare provider know; there may be a problem with the urinary tract.
If your child’s urine is pink or cola-coloured or is very dark or smells unusual, bring it to your healthcare provider’s attention right away. Kidney orliver problems may be the cause, and this needs immediate investigation. Early treatment may avoid kidney damage.
While most urinary problems are easily fixed, it is important to able to recognize problems so they can quickly be addressed.
It’s important to know that bed-wetting is not a behavioural problem, nor should it lead to a blame game between parents and children. It’s always important, as soon as the concern arises, to talk to the pediatrician to either be reassured or investigate it. It’s worse to sit on it and either worry about it or pressure your child without getting good advice about how to deal with the bed-wetting.
There are two types of bedwetting-primary and secondary. Primary bedwetting is due to a delay in the maturing of the nervous system. It is an inability to recognize messages sent by the bladder to the sleeping brain. There are a number of interventions, including medical and behavioral options.
Secondary bedwetting is wetting after being dry for at least six months. It is due to urine infections, diabetes, and other medical conditions.
The real reason for what causes bedwetting or why it stops is still a mystery. Most of the time, bed-wetting is just the delay in the developmental acquisition of nighttime bladder control and it’s not clear why some children take longer to maintain dry nights. It may also be due to hereditary issues.
The most overlooked factor that could cause bed-wetting is constipation. Constipation is a very big problem in kids. It’s not serious, but it’s very common and causes stomachaches and problems in the urinary tract. The rectum is located behind the bladder, so if the rectum is full, it can push on the bladder and lead to something urologists call uncontrolled bladder contractions, which can promote daytime wetting or contractions at night – or bed-wetting.
The size of the child’s bladder could also contribute to the problem. If it’s smaller than average, the child may urinate more frequently during the day and have less room to hold urine overnight. In other kids, the brain produces a hormone at night that reduces the amount of urine the kidneys make, causing more urine to be produced overnight. What’s more, some children have difficulty waking at night even if they experience the urge to go, causing a delay in the brain’s communication to the body to get up and go to the toilet.
If a child suffers from primary bed-wetting, he or she may not have an underlying condition. However, children who struggle with both daytime and nighttime incontinence should be screened for urinary tract infections, diabetes, sickle cell disease, sleep apnea and neurological disorders.

(The author is Senior Urologist and CMD, Pushpanjali Hospital,Gurgaon)