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  • Writer's pictureDevavrat Harshe

Bedwetting: why timely intervention is necessary?

"Doctor, we are fed up now. He deliberately does it to see us suffer. We cant handle it now", said both parents. The family was well educated and socially well off. They had everything, a nice home, settled careers, two sons, both good at studies, no major stressors at home or in family. There was nothing to complain...... except..........




Their elder son was wetting the bed at night even at the age of 15 years. What was passed off initially as a "late bloomer", and after a while as "lazy" was now a big problem for the entire family. The boy kept wetting the bed all around the year, especially during rainy and winter seasons. This initially lead to him being teased by his brother, family members and cousins. Somehow they kept it a secret from his school friends, a task that was getting more and more difficult with each passing day. He was avoiding school picnics, sleepovers, visits by friends and cousins. The family was reluctant to take him to any of their relatives, as the bedwetting continued there as well, which only lead to lectures to the boy and his parents from everyone with a mouth. The family was now at their wit's end, as the boy was now approaching SSC exams, and was planning to join his friends for a camping and trekking club.


"What do you mean, he does it deliberately'? the psychiatrist asked politely. The boy's father said, "Doctor, he passes urine in his bed, just to punish us."


"I am curious, so he passes urine in your bed?" asked the psychiatrist probingly. The father, now clearly irritated said, "Doctor dont be ridiculous! He doen't sleep with us now. He passes urine in his bed."


The doctor pushed again, "So, he passes urine in his bed, wets himself in the process, sleeps in that urine soaked bed and clothes, wakes up soiled in his own urine, cant go with his friends and cousins on picnics, is ridiculed by everyone including family members, help me understand this, why would he do it deliberately? If you feel this as a punishment to you for some reason, imagine how he must be feeling through all this?"


Nonplussed, the father said, "He should think that before wetting the bed, shouldn't he!"


Nudging past the subject, the doctor asked, "Does he pass urine in his clothes during daytime? While studying, playing, chatting, eating or any activity?" To which, both parents responded with a firm no. The doctor asked whether the boy experienced any


The doctor looked at the boy and asked, "During the daytime, do you realise everytime you get the sensation to pass urine? Are you able to control and stop the flow of urine till you reach the restroom?" The boy answered "yes, completely" to both questions. He further asked the boy whether the boy senses the urge to pass urine in sleep, to which the boy said no.

A detailed chat, history and clinical examination of the boy along with exploration of his personality (by a psychologist), dietary habits, sleeping schedule, physical health was conducted, most of which turned out to be within normal limits. Parents, having searched on google, had obtained basic blood and urine investigations, which were normal.


The psychiatrist turned to the couple and said after a thorough evaluation: "I have one good news and one not so good news for you. The good news is that your son is not doing this deliberately. The not so good news is he is suffering from "Nocturnal Enuresis". After a little uncomfortable silence, the couple asked, "Doctor, you said he is not doing it deliberately. You think this is enuresis. It means he has problem with his urine. Why did our physician refer us to you, a psychiatrist then?"


The psychiatrist replied, "In simple terms, your son's entirely filled bladder is getting emptied during night, that means enuresis. It has nothing to do with urine. All the tests you have ordered so far have shown that his urine and urinary system is normal." Puzzled, the couple asked "But why is he emptying his bladder?"


The psychiatrist said, "Remember, he is not doing it. It is happening on its own." Parents clearly had disbelief on their face, so the doctor continued, "Dont you wonder, why is he wetting the bed only at night, but can manage his urination fine during the daytime? Have you noticed, that the time at which he passes urine in bed, is always at midnight, or early morning hours?" Both questions, had the parents stumped.


The psychiatrist explained, "See, nocturnal enuresis is a sleep related problem, its right there in its name "nocturnal". Normally, we get sleep in phases of NREM-REM which are alternating. Sometimes, in children, this regulator becomes haywire, which causes children to skip a stage of light sleep. This leads to sudden passage into deep sleep, which is normally associated with relaxation of all bodily muscles. This causes bladder muscles to relax suddenly, leading to emptying of the whole bladder, and thus, bedwetting. Normally, when the bladder muscles are tonic, even a slightest tension due to urine leads to sensation of urination, which is present in your son during the day. At night however, he is in such a deep sleep, that the muscles are laxed, and there simply isnt enough time for the urination sensation to wake him up.


The couple, hesistantly asked, "So doctor, is he mentally ill?" The doctor said, "On a theoretical level, yes because sleep regulation is linked to mental state and activity. However, if you are asking whether he has a serious mental illness?, the answer is a firm no."


"So doctor, what needs to be done here"? enquired the mother and the son in unison.


"Well, success in treating enuresis depends on 1) motivation in parents and the child and 2) support and emotional acceptance of the issue by the family. First and foremost, the family should accept (not just agree, accept) the fact that he is not doing this deliberately and its not in his control. Once that happens, you should actively stop teasing him, taunting him, ridiculing him and lecturing him on the topic. This wont reduce enuresis, but will make him comfortable and relaxed" replied the psychiatrist.


This forms the bedrock for any treatment, particularly in children and adolescents, who are largely dependent on their parents for all kinds of support. The psychiatrist and psychologist advised him dietary and sleep hygeine and water restriction. which was to be followed all round the year, especially during winter months. The psychologist also advised the parents to start certain behaviour therapy principles to keep track of the progress.


"Doctor would he need any medication for this? We are worried about medications and its side effects" said the couple. "Well, the first line of treatment for enuresis is always behaviour therapy, and if it fails then to opt for medications. So far now, we will stick to behavioural modification. Keep in mind, that habits dont change readily. It will take some time for him to adopt the new lifestyle and schedule."


The family left and revisited after a week as promised. During the week, the son had 3 nights which did not see bedwetting. He was initially a bit resistant to the sudden changes and behaviour modification, however his parents' and brother's support pushed him to stick to the new rules. He was also trained about bladder strengthening exercises which he had to do during daytime.


After three months, the boy had achieved complete dry status and did not wet the bed again. As this blog is being written, he is enjoying with his friends, a camping excursion that is going to last a week. His parents are a bit worried about him remaining dry, but he is confident of his progress.


Nocturnal enuresis affects a significant number of children every year. Lack of awareness about the problem leads to ignoring it, which gets problematic as the children grow in age. Enuresis, if all other causes of urinary and physical disorders are excluded, can be treated with behaviour therapy, lifestyle modification, exercise, sleep hygeine and medication if required. To know more, contact your doctor, or psychiatrist or psychologist or mental health professional today, or visit www.dmckolhapur.com




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