What
is the cause of bedwetting, what the causes are and when you should see a
doctor? These topics were discussed in my previous article. Now today I will
inform you about the home remedy for bedwetting and
the medical treatments
available.
In
many circumstances, as you will notice, baby will gain bladder control over
time. If the child has no other
medical condition then he should be allowed sufficient time to stop bedwetting
on his/her own. The first and foremost cause behind treating bedwetting is to stop the embarrassment and fear
the child is having and reduce the frustration of the parents. Most children
find him/her alone while stopping bedwetting. Family members should support him, share their experience
and if possible can ask for help from other families who were having the same
problem.
Previously
a treatment modality was used known as Bladder Training Exercise. In this therapy, the child was
allowed to drink large amount of water and asked not to urinate until bladder
is distended and became uncomfortable. But now-a-day it is not used as it is
very much painful. Not responding to normal sensation of bladder fullness may
worsen the problem.
So
how can you help your child in home? These are some steps you can take in home:
1. Children should take
adequate amount of fluid throughout the day. If child becomes thirsty
several times during day, it indicates child is drinking less. On average your
child should take 100-130ml fluid per KG body weight during a normal day.
2. Your child should avoid
caffeine containing food especially during evening and night. It causes
production of excess amount of urine within a short period of time. That causes
bladder distension and frequent micturition. Chocolate, cola, tea etc. contain
caffeine.
3. You should monitor the normal voiding pattern during
the day. The child should take it easy during voiding, take a comfortable
posture and give optimal pressure during voiding. Make him void--
A. After getting up from
sleep,
B. Approximately after 2
hours interval,
C. Before going school or
outside the home,
D.
Before bed time
4. During school time the child should void 2
to 3 times. They should not hold their urine until the class ends. You may
inform the teacher about the problem of your child and ask the teacher to allow
him to go to toilet when required.
5. Your child must and must
use
toilet before going to bed.
6. During the night you
should awake your child to void urine. You may try it for 1 time and
usually during the middle of night.
7. Encourage your child and give some reward if your child stays
dry for several nights. Do not scold them. Most important thing is give your
child love and positive support. If the reward system does not work then do not
use it.
Alarm therapy
So
what is alarm therapy? It is a method used to improve bedwetting problem and should
be considered for every child with bedwetting problem. In this process an alarm
is attached
to child’s pant or pajama. When baby starts to void during sleep or
sometimes before voiding, the alarm goes off. With the sound of alarm, child
wakes up, goes to toilet to empty rest of the bladder urine and washes him or
her. If your child does not wake up with alarm, help him/her. In a randomized
control trial of this alarm therapy, two third children showed positive
result. Alarm therapy should be used for at least 3 months. 3 months later if
this method does not improve bed wetting you should stop trying it. Sometimes after
successful alarm therapy, bedwetting may relapse after few months.
Now
above mention steps failed or your child have other medical condition. Then you
have to visit a doctor and do some investigation, take medication for this
illness.
Desmopressin is one of the available medications for bedwetting.
It is a hormone analogue that causes decreased urine output. It should be
taken after your doctor advice it. Because it may cause fluid overload in the
body. If it is prescribed, take it 1 hour before bed time. Your
doctor will tell you the dose and duration. In a controlled trial it
showed that combination of both alarm therapy and desmopressin is more effective.
Anticholinergic is another group of drugs used in
enuresis especially for those children who have overactive bladder or some
neurological problem in bladder. These drugs decrease the contraction of
bladder. The available drugs in this group are Oxybutynin chloride and tolterodine.
These drugs may have some side effects like dryness of the mouth, constipate,
visual disturbances etc. Please consult with your doctor before any
use of medication.
Another
drug used for this condition is Imipramine. The adverse effect of
this drug is constipation, irritability decreased appetite, mood change etc.
But due to significant adverse effect World Health Organization (WHO) is
not advising to use this drug now a day.
How frequent a child should be evaluated during treatment?
There is no fixed rule but a child, during treatment should visit the doctor in
every 3 months. In each visit doctor will ask you about the improvement,
number of dry nights. If after best possible effort, bedwetting is not improved
then the child should be further evaluated by an urologist or nephrologists.
Available
alternative treatment for bed wetting.
There
are some
alternative methods available to prevent bedwetting. But these methods
are not scientifically proven nor done on evidence. Some of these methods are used
for many years. You should ask your doctor before using any of this method. Because
some of these methods may worsen bedwetting.
Remember
some important things:
1. The bedwetting condition
is curable.
2. You should not criticize
your child for bedwetting rather encourage him.
3. If the child has no other
medical condition try home treatment mentioned earlier for bedwetting.
4. If home treatment failed
after 3 months or baby has any medical disease consult with your doctor.
5. Most important thing is never take any drug without permission
from your doctor.
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