If your child wets his bed after he has been toilet-trained (usually after five years of age), take it in your stride.

Enuresis, or more commonly referred to as bedwetting, is a condition where your child is unable to control his bladder when sleeping, leading to involuntary urination.

Children who suffer from nocturnal enuresis may have less control of their bladders than they would like, leading to “accidents” where they wet their bed at night.

It is important to note that you should NOT punish or cause him embarrassment for bedwetting.

It is something that is out of his control at this point, and he is probably even more embarrassed or ashamed of it than you might imagine.

In general, 5%-10% of children aged five to 10 years have enuresis; 2%-3% in those aged 11-14 years; and 1%-2% in those above 15.

In fact, in one out of 100 of these children, the problem may persist till adulthood.

Causes of enuresis

The exact cause of nocturnal enuresis is unknown. However, there are several possible reasons:

• Hormones: The body produces an antidiuretic hormone (ADH) that causes it to produce less urine when asleep. A lack of ADH may lead to more urine being produced when asleep.

• Bladder: Muscle spasms may prevent the bladder from holding more urine. Some people may also have a smaller than normal bladder.

• Genetics/familial: Older children who suffer from enuresis often have at least one parent who also had this problem, and at a similar age.

• Deep sleep: Your child might be so deeply asleep that he is unable to wake up to pee.

• Diuretics: Certain chemicals (e.g. caffeine, carbonated drinks) can cause more frequent urination.

• Medical conditions: Certain medical conditions can trigger secondary enuresis. These include diabetes, urinary tract abnormalities (a child born with an abnormal urinary tract), constipation and urinary tract infections (UTIs).

Spinal cord trauma, such as severe stretching of the spinal cord due to a fall, sports injury or an auto accident, may also play a role in enuresis, although this is rare.

• Stress: Traumatic events such as parents divorcing, death (friend or family member), moving to a new city, changing school or any sudden changes can cause stress in children. This may lead to enuresis.

Managing the problem

Bedwetting, enuresis, Star2.com

Five percent to 10 of children aged five to 10 years have enuresis.

Consult your child’s paediatrician to learn more about nocturnal enuresis. It is important to do so in order to exclude the probability of a medical problem.

This will involve a physical examination and his full medical history. The physical examination may include a urine analysis to test for signs of disease.

As nocturnal enuresis is not necessarily caused by disease, don’t worry if the test results are normal.

His paediatrician may also need to ask for seemingly unrelated information, such as sleeping habits or patterns, bowel movement, and urinary signs or symptoms (e.g. frequent urge to pee or pain/burning sensation during urination).

This phase may take some time to resolve and your child will likely continue to wet his bed.

In the meantime, you can try to make the problem more manageable by:

• Using a waterproof cover: Line the bed with a waterproof liner to keep his bed dry.

• Provide easy access to the toilet: Position his bed as close to the toilet as possible. If he sleeps in a bunk bed, let him use the bottom bunk.

• No babying allowed: Do not wake your child to go to the toilet as this is counterproductive in the long term.

Older children may also want to change their clothes/bedsheets at night, so do provide them with spares.

• No drinks before bedtime; early dinner time: This helps to minimise the amount of fluids in his body, and thus, hopefully prevent an overly full bladder. This will reduce the chances of wetting the bed or minimise the amount.

However, take care to provide him with plenty of water during the day to prevent dehydration.

• Foods/drinks to avoid: Certain foods/drinks may make things worse. In general, avoid anything that has caffeine in it as it acts as a diuretic, meaning that it causes the urge to urinate.

The list of foods/drinks includes coffee, tea, chocolate, and sodas or other carbonated beverages that contain caffeine.

Use an alarm pad

This little gadget consists of a sensor and an alarm, which will wake your child up if he wets his bed.

The idea behind this is to “train” him to wake up by himself, and over time, he will hopefully wake up before he wets his bed.

The key is to wake up quickly before the bed is too wet. The sooner he can wake up, the more effective it will be in modifying his behaviour.

However, do be patient as this will take at least a month before you can see whether there will be any improvement.

Unfortunately, this method may not be suitable if your child shares a room with others (e.g. with siblings or parents).

Of course, there is no harm in talking to your child’s paediatrician for ideas on how to cope with enuresis.

As a last resort, your child’s paediatrician may even prescribe some medication for it.

Do note that no medicine has been proven effective in permanently “curing” bedwetting, and worst of all, bedwetting may resume when the medication is stopped.

Full commitment from parents/caretakers is crucial in managing enuresis; do not just rely on medication alone.

Rest assured that, yes, there is good news – bedwetting will often “clear up” by itself.

If you feel overwhelmed, discuss it with your child’s paediatrician – he may have some suggestions on how you can cope with it.

Alternatively, you could even check with your own parents to see whether you went through a similar episode yourself, and if so, how they handled it.

Dr Mohamad Ikram Ilias is a consultant paediatrician (nephrology). This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.