Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)
Nocturnal enuresis (bed-wetting) is very common in the first few years of life in children after toilet training and most children outgrow their bed-wetting as this survey of 1265 children in New Zealand shows:
| Age (years) | Children with Nocturnal Enuresis (%) |
| 3 | 43.2 |
| 4 | 20.2 |
| 5 | 15.7 |
| 6 | 13.1 |
| 7 | 10.3 |
| 8 | 7.4 |
Some bedwetters do not produce the normal high levels of vasopressin (a hormone that helps recycle water from urine) at night and therefore make more dilute urine than they should at night. In addition, they don't seem to get the message that the bladder is full and as a result have accidents when asleep.
Bed-wetting in a child can be a symptom of urinary tract infection or abnormalities of the urinary tract and, if associated with painful urination, stream abnormality, or daytime incontinence, should be fully evaluated. Usually a diagnosis of isolated bed-wetting can be made by an expert pediatric urologist after performing a careful history, physical examination, and inspection of the urine (and, in some situations, ultrasound or other imaging tests).
Because most bedwetters become dry without treatment, patience and understanding are the best things to offer young children who bed wet. However, by 6-7 years of age children are eager to go to camp or on sleepovers and treatment may be desired.
If the child is not fully dry by 7 years, we recommend a visit to a pediatric urologist clinic.
As an initial step we recommend fluid restriction. This may be enough for some children, but even if not successful is continued when other treatment programs are started. Some parents also find that waking the children at night may help, but this should be done only if does not disrupt sleep patterns (the child and parent!). Bedwetting alarms if used properly are very effective, we will be glad to advise you regarding them. Behavioral modification is occasionally helpful, with a reward system for dry nights. However, the child should not be punished for wetting. Medications may be necessary as a last resort.
Imipramine (an antidepressant known as Tofranil) helps in a little more than 50% of bedwetters, but it can cause mood changes and nightmares. Oxybutynin chloride (a bladder antispasmodic) also is effective in half the children but may cause facial flushing, irritability, and even heat exhaustion (making it essential that children drink plenty of water in the summer months. DDAVP (a synthetic version of vasopressin, an important regulatory hormone that our bodies normally produce) may be prescribed. DDAVP recycles water from the urine back into the bloodstream so less urine is made at night. Children should be followed carefully when on any of these medications and dosages should not be increased without careful instructions from the doctor. If you have any questions about your child's condition, please do not hesitate to talk with one of our staff.
Bedwetting alarms have a small sensor which can be fixed in a child’s underwear and the alarm rings the moment child passed first few drops of urine. The sensor communicates to the alarm machine via a blue tooth connection. Bedwetting alarms are very effective for children with bedwetting but require a certain amount of commitment from the child and the family. Ideally, they should be started under guidance of a pediatric urologist or a nephrologist so that parents and child can start using the alarm properly for best results.
Bedwetting alarms can be ordered online in India after a proper consultation with a pediatric urologist to make sure that there is no other disease-causing nocturnal enuresis. The cost of a bedwetting alarm in India is around 2500 Rs (2019).
Dr A.K.Singal is a renowned Pediatric Urologist living and working in Navi Mumbai. He is an expert in diagnosing and treating cases of bedwetting or primary/ secondary nocturnal enuresis in children. Children from all over Mumbai, Navi Mumbai, Thane and Pune come to his clinic for diagnosis and treatment of enuresis and bedwetting.
