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When night falls


Nocturnal enuresis is associated with low self-esteem, depression and specific learning disorders. But it is controllable with therapy.


When the children of Std. VII were preparing to go for a four-day excursion to Kodaikanal, 13-year-old Pratap was apprehensive. Although his parents had given him permission, he was undecided. Finally his father had a talk with him and told him of his own first overnight school excursion. When he had finished Pratap said, "My night problem, dad. I am worried. Did you have any such embarrassment?" His father did not understand. Pratap said, "I cannot go for the excursion. I am sure my friends would come to know and they will ridicule me. Please dad, tell me, how to keep myself dry? I don't want to wet my bed at night. I want to go for the excursion but at the same time I don't want to be humiliated."

Fifteen-year-old Anitha's mother says, "I don't know how to begin. My daughter has been dry from the age of three. But for the last three months she has been wetting her bed. Her class teacher says that she has to go to the toilet after every class. Now our major concern is during her monthly periods. She not only wets the bed but also stains the bed despite the napkin. What should I do?'

Anitha had lower abdominal pain and a burning sensation while passing urine. Her urine was sent for testing and it was detected to be urinary tract infection. She was treated with appropriate antibiotics. As the bedwetting is secondary to infection this condition was diagnosed as secondary nocturnal enuresis.

Pratap has been wetting his bed as well. His father used to wet his bed till he was 18 years. His mother too was a bed wetter. He has inherited the tendency from his parents. This is called primary nocturnal enuresis.

Normally a child is dry by the age of four or five. Around seven per cent of children wet their beds at five while four per cent continues to wet till ten. Boys do it more frequently than girls. By 18 years only one per cent of the population continue to wet their beds.

Heredity is an important factor. If one of the parents was a bed wetter, the child has 40-50 per cent chance of bedwetting. If both parents were bed wetters, the child has a 70-80 per cent possibility of being one. These children usually outgrow their problem at about the same age as their affected parents. However, they should be investigated for urinary tract infection, congenital abnormalities of the urinary tract, urinary flow abnormalities, emotional disturbance, diabetes, and so on. When no reason is found they are taught bladder exercises, to postpone voiding and thus increase the capacity of the urinary bladder.

Restricting water intake though advised is not practical. Night voiding before sleep should be practiced. Parents should wake their teenagers at regular intervals and remind them to go to the toilet. Access to the toilet must be easy. Do not make fun or punish. Siblings ought to be requested to help them overcome the problem. Reward charts for dry nights are encouraging. Family must keep the adolescent in good humour.

Nocturnal enuresis has been associated with low self-esteem, depression and specific learning disorders. School performance, quality of life and interpersonal relationships are often affected.

Enuresis is controllable with therapy. There are effective medications to give dry nights. Encourage children to share their problems and thus achieve better quality of life.

The author is a Chennai based Consultant Paediatrician and Adolescent Physician.


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