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Cover page of the Journal of Health Sciences


 
 Table of Contents  
EDITORIAL
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 103-104

Bed wetting


Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University); KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and M.R.C, Belagavi, Karnataka, India

Date of Web Publication18-May-2018

Correspondence Address:
Dr. R B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed--to--be--University); JNMC Campus, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_140_18

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How to cite this article:
Nerli R B. Bed wetting. Indian J Health Sci Biomed Res 2018;11:103-4

How to cite this URL:
Nerli R B. Bed wetting. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Jun 25];11:103-4. Available from: http://www.ijournalhs.org/text.asp?2018/11/2/103/232681



Bedwetting, also known as nocturnal enuresis, is an uncontrollable leakage of urine while asleep. It is a common problem in childhood. Approximately 5%–10% of all 7-year-old regularly wet their beds. World Bedwetting Day is held every last Tuesday in May to raise awareness among the public and health-care professionals that bedwetting is a common medical condition that can and should be treated. This year the world bedwetting day is being held on May 29. World Bedwetting Day was initiated and supported by the World Bedwetting Day Steering Committee, which consists of the International Children's Continence Society (ICCS), the European Society for Paediatric Urology (ESPU), the Asia Pacific Association of Paediatric Urology, the International Paediatric Nephrology Association, the European Society of Paediatric Nephrology, the Sociedad Iberoamericana de Urologia Paediatrica, and the North American Paediatric Urology Societies.

It is believed that the most common reasons for bedwetting include reduced bladder capacity, difficulty in waking up and/or overproduction of urine at the night time. As bedwetting is not an acute health problem, parents often delay in seeking advice from health-care professionals. However, today we know that bedwetting has a severe impact on the child regarding school and social performance, emotional well-being and self-esteem, and also daytime functioning. Parents should be aware that bedwetting can be treated and that they should speak to health-care professionals and seek further support.

The ICCS and the ESPU announced the launch of World Bedwetting Day at the 26th ESPU Congress in Prague in the year 2015. “Bedwetting is nobody's fault,” “It is a common medical condition that families and doctors should be able to discuss without embarrassment or guilt. World Bedwetting Day is a great opportunity to raise awareness of the condition so that children and families can get the help they deserve.”

Children who suffer from bedwetting often feel a sense of shame, frequently isolating themselves and missing out on social activities such as sleepovers at friends' houses and school trips.[1],[2] Nearly half of parents do not seek help from their doctor for the treatment of bedwetting in children 5 years or older, believing the child will outgrow the problem.[3] However, bedwetting will not necessarily go away by itself, and safe and effective bedwetting treatments are available.[4],[5]

The NICE guidelines [6] believes that bedwetting is a widespread and distressing condition that can have a deep impact on a child or young person's behavior, emotional wellbeing and social life. It is also very stressful for the parents or carers. The key points for implementation include the following:

  • Inform children and young people with bedwetting and their parents or carers that bedwetting is not the child or young person's fault and that punitive measures should not be used in the management of bedwetting
  • Offer support, assessment, and treatment tailored to the circumstances and needs of the child or young person and parents or carers
  • Do not exclude younger children (for example, children under 7 years) from the management of bedwetting on the basis of age alone
  • Discuss with the parents or carers whether they need support, particularly if they are having difficulty coping with the burden of bedwetting, or if they are expressing anger, negativity or blame toward the child or young person
  • Consider whether or not it is appropriate to offer alarm or drug treatment, depending on the age of the child or young person, the frequency of bedwetting and the motivation and needs of the child or young person and their family
  • Address excessive or insufficient fluid intake or abnormal toileting patterns before starting other treatment for bedwetting in children and young people
  • Explain that reward systems with positive rewards for agreed behavior rather than dry nights should be used either alone or in conjunction with other treatments for bedwetting. For example, rewards may be given for:


    • Drinking recommended levels of fluid during the day
    • Using the toilet to pass urine before sleep
    • Engaging in management (for example, taking medication or helping to change sheets).


  • Offer an alarm as the firstline treatment to children and young people whose bedwetting has not responded to advice on fluids, toileting, or an appropriate reward system, unless:


    • An alarm is considered undesirable to the child or young person or their parents and carers or
    • An alarm is considered inappropriate, particularly if:
    • Bedwetting is very infrequent (that is, <1–2 wet beds per week)
    • The parents or carers are having emotional difficulty coping with the burden of bedwetting
    • The parents or carers are expressing anger, negativity, or blame toward the child or young person.


  • Offer desmopressin to children and young people over 7 years, if:


    • Rapid-onset and/or shortterm improvement in bedwetting is the priority of treatment or
    • An alarm is inappropriate or undesirable.


  • Refer children and young people with bedwetting that has not responded to courses of treatment with an alarm and/or desmopressin for further review and assessment of factors that may be associated with a poor response, such as an overactive bladder, an underlying disease or social and emotional factors.




 
  References Top

1.
Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S, et al. Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2012;171:971-83.  Back to cited text no. 1
    
2.
Reddy NM, Malve H, Nerli R, Venkatesh P, Agarwal I, Rege V, et al. Nocturnal enuresis in India: Are we diagnosing and managing correctly? Indian J Nephrol 2017;27:417-26.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Schlomer B, Rodriguez E, Weiss D, Copp H. Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care. J Pediatr Urol 2013;9:1043-8.  Back to cited text no. 3
[PUBMED]    
4.
Lottmann H, Baydala L, Eggert P, Klein BM, Evans J, Norgaard JP, et al. Long-term desmopressin response in primary nocturnal enuresis: Open-label, multinational study. Int J Clin Pract 2009;63:35-45.  Back to cited text no. 4
    
5.
Evans J, Malmsten B, Maddocks A, Popli HS, Lottmann H; UK Study Group. Randomized comparison of long-term desmopressin and alarm treatment for bedwetting. J Pediatr Urol 2011;7:21-9.  Back to cited text no. 5
[PUBMED]    
6.
O'Flynn N. Nocturnal enuresis in children and young people: NICE clinical guideline. Br J Gen Pract 2011;61:360-2.  Back to cited text no. 6
    




 

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