NOCTURNAL ENURESIS (Bed Wetting )

This is uncontrolled urination at night and the age when bladder control should have been achieved.
Urination occurs involuntarily in childhood but control over it begins between ages 2-6 years.
As one grows older, between the ages mentioned above, there is development of a hormone cycle which releases small amounts of the hormone ADH which antagonises urine formation at night. This cycle decreases urination at night.

Nocturnal enuresis is normal in children up to 3 years. It becomes a problem if it persists after age 6. Children with this usually suffer low self esteem.

Nocturnal enuresis is classified primary when there is no dryness for a prolonged period.
It is secondary when there is dryness for a period of about six months and then resumption of bedwetting.

CAUSES
*Developmental delay neurologically to sense bladder fullness. Small bladders may also fill early adding to the problem.


* Genetics have been known to play a role as victims of the problem have their parents facing it in childhood.

* Alcohol and caffeine increase urine formation and may be a cause for some children.

* Increased intra-abdominal pressure from constipation, over eating etc may press on the bladder causing the problem.

* This may be the only sign in diabetes for some children. Urinary tract infections may also be a cause.

* Sleep walking

* Heavy sleeping

* Decreased ADH secretion.

* Change of environment

* Improper toilet training at younger ages.

MANAGEMENT
1. Void before sleeping, no late drinks.

2. Night calls to void, alarms
3. Support and encouragement.
4. Synthetic ADH administration
5. Anticholinergics
6. Excluding renal tract anomaly and infection.
The really great men of earth are never known by their titled names, or seldom so. so significant has been their services, so distinguished their gifts, that their simple name is enough...
.... Harry Moyle Tippert