BEDWETTING

BEDWETTING – HOLISTIC APPROACH TO A COMMON CHILDHOOD PROBLEM

Bedwetting is also known as night time incontinence or nocturnal enuresis. Generally, bedwetting before age 7 isn't a concern. At this age, your child may still be developing night time bladder control. Most children wet the bed occasionally or even nightly during the potty training years. Bedwetting in children is often simply a result of immaturity. The age at which children become able to control their bladders during sleep is variable. Bladder control is a complex process that involves coordinated action of the muscles, nerves, spinal cord and brain. Wetting the bed can be upsetting, especially for an older child. Child may feel bad and be embarrassed. Can help them by being loving and supportive. Try not to get upset or punish child for wetting the bed.

Parents must realize that enuresis is involuntary. The child who wets the bed needs parental support and reassurance. Most children simply outgrow bedwetting with a rate of resolution of the issue of about 15% per year.

The prevalence of childhood primary enuresis is: 5 years old 16%, 6 years old 13%, 7 years old 10%, 8 years old 7%, 10 years old 5%, 12-14 years old 2% - 3%, over 15 years old 1%- 2%.

Types of Bedwetting

There are 2 types of bedwetting: primary and secondary. Primary means bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts up after the child has been dry at night for a significant period of time, at least 6 months.

Causes:

Primary Bedwetting: The cause is likely due to one or a combination of the following:

The child cannot yet hold urine for the entire night. The child does not waken when his or her bladder is full. The child produces a large amount of urine during the evening and night hours. The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents usually are familiar with the leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.

Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting.

No one knows for sure what causes bedwetting, but various factors may play a role:

Small bladder. Child's bladder may not be developed enough to hold urine produced during the night. Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.

Hormone imbalance. During childhood, some kids don't produce enough antidiuretic hormone (ADH) to slow night time urine production.

Stress. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bedwetting.

Urinary tract infection. This infection can make it difficult for child to control urination. Signs and symptoms may include bedwetting, daytime accidents, frequent urination, red or pink urine, and pain during urination.

Sleep apnea. Sometimes bedwetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, or daytime drowsiness.

Diabetes mellitus. For a child who's usually dry at night, bedwetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.

Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bedwetting at night.

Structural problem in the urinary tract or nervous system. Rarely, bedwetting is related to a defect in the child's neurological system or urinary system.

Inherited cause - Bedwetting does tend to run in families. Many children who wet the bed have a parent who did too. Most of these children stop bedwetting on their own at about the same age their parent did.

Clinical Manifestations

Bedwetting is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected. Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bedwetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

Most children outgrow bedwetting on their own — but some need a little help. In other cases, bedwetting may be a sign of an underlying condition that needs medical attention.

Bedwetting needs more attention when child still wets the bed after age 7, child starts to wet the bed after a few months or more of being dry at night & Bedwetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring

Diagnosis:

Child will need a physical exam. Depending on the circumstances, physician may recommend: Urine tests to check for signs of an infection or diabetes, Xrays or other imaging tests of the kidneys or bladder, if suspects a structural problem with child's urinary tract or another health concern., Other types of tests or assessments, if other health issues are suspected

Complications:

Although frustrating, bedwetting without a physical cause doesn't pose any health risks. However, bedwetting can create some issues for child, including:

·        Guilt and embarrassment, which can lead to low self esteem

·        Loss of opportunities for social activities, such as sleep overs others home and camp

·        Rashes on the child's bottom and genital area — especially if child sleeps in wet underwear

MANAGEMENT

Home Managements:

Making some changes at home may help for children’s like:

·        Anxiety and stress tend to make bedwetting worse. So, instead of blaming or punishing child, treat child with love and support to relieve their embarrassment.

·        Encourage child to empty the bladder just before going to the bed.

·        Install night-lights and make sure that child has easy access to the bathroom at night.

·        Offer simple reinforcements or rewards when there are dry night.

·        Encourage child to drink more fluids during morning and afternoon but limit fluid intake in the evening.

·        Avoid caffeinated beverages, even hot chocolate, as caffeine stimulates the bladder.

·        Treat constipation. Urine control and stool elimination use the same muscles. With chronic constipation, these muscles become dysfunctional and contribute to bedwetting.

·        Use waterproof sheets to protect the mattress.

·        You can also use a bedwetting alarm.

Home remedies

Bedwetting is not a problem that can be solved in a day or two. Be patient and allow these remedies time to work.

·        Cinnamon. It is believed that this spice keeps the body warm. Have your child chew a piece of cinnamon stick thoroughly once a day. You can also combine sugar and cinnamon powder and then sprinkle it on buttered toast. Give this toast to child for breakfast.

·        Indian Gooseberry also known as amla, is an excellent Ayurvedic remedy for bedwetting. Crush and deseed two Indian gooseberries. Add one tablespoon of honey and a pinch of turmeric. Give one tablespoon of this mixture to your child every morning. Another option is to give your child one teaspoon of the pulp of Indian gooseberry mixed with a pinch of black pepper powder.

·        Olive oil Massage- For an easy treatment to cure bedwetting, you can use olive oil. Simply heat some olive oil and when it is comfortably warm, rub it over your child’s lower abdomen and then massage the area gently for several minutes. Follow this remedy daily until you are satisfied with the results.

·        Cranberry juice is good for the bladder and urinary tract. Although most liquids should be avoided soon before bed, you can give your child a cup of fresh cranberry juice one hour before going to bed. Repeat this process daily for at least a few weeks. If bedwetting is due to urinary infection, give your child one-half cup of cranberry juice three times a day.

·        Walnuts and Raisins can also be used to reduce the frequency of bedwetting. Many children will enjoy this as a tasty snack. Give your child two walnuts and five raisins before going to bed. Repeat this remedy for at least a few weeks or until you see positive results.

·        Bladder Exercises help stretch the muscle that controls the release of urine from the bladder and increase bladder capacity. Muscle-strengthening and bladder-stretching exercises are considered good for bladder control.

·        Honey - Many children like the sweet taste of honey, making this an easy remedy to try. Simply give your child one teaspoon of raw honey before bed. You can also give your child a spoonful of raw honey mixed in milk for breakfast.

·        Apple Cider Vinegar helps balance the body’s pH and reduce acid levels which may be contributing to the problem. It will also aids detoxification and treat constipation. Stir two teaspoons of apple cider vinegar in a glass of water. Optionally, add a little raw honey.

·        Mustard Seeds can be of great help to those suffering from urinary tract infections. Stir one-half teaspoon of dry mustard seed powder in a cup of warm milk. Give this drink to your child at night one hour before going to bed.

·        Jaggery has a heating effect on the body. When the body remains warm from inside, the problem of bedwetting vanishes soon. Each morning give your child a small piece of jaggery along with a cup of warm milk.

HOMOEOPATHIC MANAGEMENT

Homoeopathy has been found to be very successful in treating bedwetting and medicines are perfectly safe. These natural homoeopathic remedies do not have any side effects at all. Safety of the medicines is a major issue when you are to give any medicine to your child. Therefore it is of utmost importance that the medicines should be completely safe. Homoeopathic remedies are known to be perfectly safe and have been tried by millions of patients all over the world over the last 2 centuries.

The aim of Homoeopathy is to strengthen the nervous system of the body. This allows the child to gain control over the urinary bladder. The same child who had been urinating in the bed for years is able to keep the bed dry within a matter of a couple of weeks. Homoeopathy offers the best way of treating bedwetting. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. Please consult a qualified homoeopath before taking any homoeopathic remedy.

Indicated Remedies	Indications
Equisetum	One of the most common remedies for nocturnal enuresis and mainly used on a child that wets the bed during dreams or nightmares. Equisetum treats other forms of urinary incontinence such as passing water without any cause, with involuntary stools, or with clear light-coloured without feeling any relief. It can also be used on a child having the constant urge to urinate.
Argentum Nitricum	It can be used to treat bed wetting problems of a child who feels anxious about upcoming events (exams, performances, etc). The homoeopathic treatment’s principle is “like cures like” or simply put, the very substance that causes the same symptoms as a serious disease is taken to treat or prevent that disease.
Belladonna	it can be used to treat bed wetting children, specifically those who have frequent and profuse urination after midnight toward the morning. In addition, Belladonna is also effective in treating nocturnal enuresis caused by illness or bladder infection.
Sulphur	Usage is suggested for a nocturnal enuresis sufferer who loves sweets and spices and who wets the bed past the first half of the night. Sulphur can also be used on a warm-blooded bedwetter who sleeps with his feet sticking out of the covers or if the child has vivid dreams.
Causticum	It is recommended for a bedwetting child who is a light and uneasy sleeper. The homeopathic remedy can also be used for a patient who unintentionally passes water when he laughs, sneezes or coughs.
Sepia	Aside from bed wetting, Sepia can also be used as homeopathic treatment for kidney problems. It is recommended by most homeopaths to treat female children with nocturnal enuresis, especially if they wet the bed on the first part of the night or if they love dancing and any vigorous activities.
Kreosote	the child is so deep asleep that it is difficult to waken him. The urine is offensive in odor. The child even has dreams of urinating. Even during the daytime, the child finds it difficult to exercise control over the urinary bladder and has to run when feels the urge to urinate.
Cina	The child is irritable and rubs the nose. The urine is turbid and white, which turns milky on standing. Increased appetite is another prominent symptom that indicates Cina.