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Wet nights, sad mornings: The Physiology of bedwetting

Bedwetting (nocturnal enuresis) is the repeated voiding of urine into bed or clothes. 

Most children recall having experienced a dream in which they had an act of urination, with the feeling of wet clothes against their body awakening them. 

Although it is commonest among children older than 5 years, a few adults may experience bed-wetting too. 

In this article, we’ll understand what brings about bed-wetting and how it can be stopped.

What causes bedwetting?

Several factors contribute to bedwetting. It could be a consequence of a mismatch between nocturnal urine production, nocturnal bladder storage capacity, sleep architecture or ability to arouse from sleep.

Abnormalities of the Genito-urinary tract, medical conditions, lifestyle factors or certain medications may affect one’s sleep architecture.

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  • In children with nocturnal enuresis, there is a reduced functional bladder capacity which might as well be associated with instability of detrusor muscles, such patients might even have normal daytime bladder storage capacity and dynamics.

    Additionally, nocturnal enuresis might be a result of bladder outlet obstruction affecting bladder storage function both at daytime and in the night.

    In the brain, the part responsible for arousing from sleep and that for bladder control are strongly linked. Children might have a mild neuro-developmental delay which affects communication between the bladder and the brain.

    This impairs relay of signals from a full bladder to the brain and by the time this happens, they have already wet the bed.

    Risk factors for bedwetting

    Family history of bedwetting

    A study found that half of all children with bedwetting had parents who struggled with the same. The likelihood was higher in those who had both parents with history of nocturnal enuresis.

    Being male

    Although both males and females may have bedwetting episodes, males have a higher likelihood of this problem persisting to an older age.

  • Long term use of disposable diapers and delayed toileting

    Use of disposable diapers prolongs the start of toilet training for most parents. It was found that children who start toilet training after 2 years of age have a higher risk of enuresis compared to those who start earlier.

    Sleep quality and sleep disorders

    Most children with nocturnal enuresis are deep sleepers and have been found to possess high arousal thresholds.

     As a result, it is difficult for these children to quickly awaken and empty their bladders when the need arises while they are asleep.

    Consuming sugary drinks

    When sugar levels in the body are high, thirst is stimulated causing your child to take in more water. Taking in sweet drinks just before bed-time may precipitate bed-wetting as sugar is an osmotic diuretic.

    Less water intake

    Not drinking enough water, at least 500ml during the day can increase your child’s risk of bed wetting. A study found that children who drink less during day time end up with chronic low-grade dehydration.

    Their functional bladder storage capacity is reduced and they have increased thirst in the evenings.

    Effects of bed-wetting

    Parents of children with this problem as well as children with nocturnal enuresis are greatly affected.

    • First, bed wetting has an influence on the child’s social, emotional and psychological development. 

    As children get older, they notice that not all of their peers are faced with this challenge and consequently get overly self-cautious; they cannot normally interact with other children of their age.

    • Mental pressure to the family: parents of these children might be stuck on finding where they went wrong. Sometimes blaming themselves for it. 

    Bedwetting is not something that is freely discussed with friends and other community members and as such may come with some sort of stigma.

    • Poor sleep quality in children. The fact that these children have to take off some time in the middle of the night to change their wet beddings and clothes creates a gap in their sleep duration. 

    For some, it is the fear of falling asleep in anticipation of urination onto their bed.  

    • Low self esteem and poor academic performance
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    How can bedwetting be stopped permanently?

    Bed wetting for most children resolves as they get older. However, before this problem can be completely resolved, a lot of unrest exists amongst these children and their parents. Here are some tips on how to overcome it permanently 

    Regulating fluid intake

    Keeping hydrated is in fact very good for our bodies. However, making sure that the greater percentage of your daily water intake is during the day time and restricting fluids in the evening hours is a good move.

    Stop giving fluids to your child at least 2 hours before bed-time.

    Avoiding vigorous physical activity before bed time

    Physical activity increases the body’s demand for water. If your child engages in such activity just before sleep time, they are sure to drink more and increase their chance of wetting their bed later.

    Routine voiding of urine 

    Regular use of the toilet especially during the day within short intervals of at least 2 to 3 hours is a form of bladder training. It allows

    Use of bed-wetting alarms

    These are devices to help your child enjoy drier nights. The alarm has a sensor and goes off as soon as the sensor gets wet.

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Improving sleep quality 

Children with nocturnal enuresis have poor sleep quality. This can be improved by maintaining a consistent sleep routine as well as avoiding vigorous activity before bed time.

Alternatively, imploring natural supplements for better sleep can be of significant impact. Supplements particularly those containing folate, vitamin B12 and melatonin. 

These are important for neuronal development as well as better sleep at night.


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