INTORDUCTION:
- Bed wetting or ENURESIS is known as the inability to control urinating in the bed during day or night.
- Here we deal with involentery urination during sleep at night medically named as "nocturnal enuresis".
- This may occur every night or weekly twice or thrice.
- Bed wetting cannot be considered abnormal until the age of 5yrs and medical attention will be required if the problem persists over the year of 5.
- Bed wetting makes psycho-social problem to the child that the child is frequently teased by others even by parents.
- These children also face the difficulty to sleep with their friends and relatives.
- Though paediatricians do not consider this as a serious problem,this is a common irritative problem in many families with anxious expectation for a cure.
COMMON CAUSES:
- Bed wetting is considered as a developmental delay in the normal process of neurological control of urination.
- Genetics play a major role in this condition that majority of victims have enuretic mother or Father .
- Anti-Diuretic Hormone (ADH) also known as Vasopressin is responsible to slow down the production of urine during sleep which is low in the victims causing bed wetting.
- Other reasons for bedwetting include spinal cord lesions, constipation, anxity, Urinary tract infections, Diabetes, Kidney diseases, anatomically small urinary bladder.
SYMPTOMS:
- The symptom in bed wetting is urinating in the bed at night atleast twice per month.
- The child find the bed is wet while he/she wakes up.
- Pain may be felt during urination associated with urinary tract infections.
- Some of the following symptoms may present in the day time include wetting in the day, increased frequency of urination, burning, urgency, dribbling, constipation.
DIAGNOSIS:
There is no specific investigation which find out the exact cause of Bed wetting, But the following investigations can be done to get a better diagnosis.
1.X-Ray KUB
2.Ultrasonogram KUB
3.Routine Urine test.
These investigations help to find out whether the patient is suffering from kidney diseases , bladder diseases like Bladder instability or Urinary Tract Infections.
Uro-dynamics study is done to evaluate the bladder and urethral sphincter function in accordance with the brain and spinal cord during filling and emptying of bladder.
The following points should be remembered in diagnosis.
- Family history with reference to the problem
- Duration of problem -childhood or recent,
- Aggravating factors like food and activities,
- Other symptoms like pain or difficulty when urinating, History of Stress and anxity in the child.
COMPLICATIONS:
There are no significant physical complications in bed wetting but the children tends to be Guilty and some go for Psycho somatic problems.
PREVENTION:
- Give moral support and assurance to your child as it a very common problem which can be corrected in practice.
- Don't try to punish.
- Train the child for regular toileting and keep not to hold urine for long time.
- Make sure urinating before going bed.
- Avoid drinking excess fluids few hours before going to sleep but not restrict plenty of fluids in the day time.
- Reward your child for dry nights.
- Let the child to note bed wetting in a chart or diary which will help the child aware.
- Bed wetting alarms can be used. This alarm wakes the child or parent when the child start urinating which help to use toilet.
IN MY CLINICAL PRACTICE:
- In my routine practice, bed wetting cases are not so common.
- Many parents share their children's bed wetting history during their own health checkups.
- It's a great pleasure to know that most of the parents take this problem easy which indicate the public awareness regarding the same.
- Some of illiterate parents give grievous punishments to their children for bed wetting due to their ignorance but feel sorry after knowing the fact.
- I have treated some of bed wetting cases successfully with Siddha medicine.
- The said cases are with the age group of 8-10 years also indicated for treatment by
concerned medical experts. - Few of them were under treatment for previous months from paediatrician.
- Response to Siddha medicine in such cases are excellent and miraculous. It is a great thing that all the patients have got satisfactory results within 4 weeks treatment.
- Follow up study held and no cases with recurrence reported.
Dr.Selvin's
