Enuresis popularly known as bedwetting refers to the unintentional passage of urine during sleep, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence. This is normal for children below the age of 5 years as their body is learning to bladder control; most children achieve some degree of bladder control by age 4, they usually achieve daytime control first while nighttime control follows. The age at which a child achieves bladder control varies, but some parents expect dryness at a very early age.

Enuresis or bedwetting in children is no one\’s fault. Avoid blames and avoid scolding the child because that might add to the stress and make the situation worse.

Types of Enuresis Or Bedwetting

Primary:

Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time; this usually indicates immaturity of the nervous system. A bedwetting child does not recognize the sensation of the full bladder during sleep and so will not wake up from sleep to urinate in the toilet.

Factors that cause primary bedwetting or enuresis include:

1. The child cannot yet hold urine for the entire night because his bladder control is delayed, making it difficult for them to hold the urine all night, resulting in bedwetting.

2. The child does not wake when his bladder is full. Some children sleep very deeply sometimes that they miss the brain\’s signal that the bladder is full and end up wetting the bed.

3. The child produces a large amount of urine during the evening and night hours. Antidiuretic hormones (ADH) prevent the body from creating excess urine at night. If a child\’s body is not producing enough of this hormone, then it produces more urine at night.

4. The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can.

5. Lower urinary tract dysfunction could be another reason for bedwetting. In this condition, there would be a dis-coordination between the bladder and the bladder outlet, and this causes the bladder not to empty effectively resulting in bladder muscle stiffness.

5. According to research, in families where both parents had nocturnal Enuresis (involuntary urination), there is a 77% chance that the children might develop it too. And if one of the parents had the problem, then there is a 45% chance. The chances of bedwetting would be only 15% if neither of the parents had the habit of bedwetting.

6. Psychological factors also play a role in the development of bedwetting, although studies found that this relationship could be coincidental. Children with a bedwetting habit are said to have a 2.88 times higher risk of having Attention Deficit Hyperactivity Disorder (ADHD), which could be due to delayed central nervous system development. But, this does not mean all bedwetting children would have psychological issues, and it is best to consult your doctor to clarify the same.

Secondary:

Secondary bedwetting refers to bedwetting that starts again after the child has been dry at night for a significant period (at least six months).

Factors that cause secondary bedwetting or Enuresis:

1. Some children could develop secondary bedwetting due to urinary tract problems such as tumors. However, there would be other symptoms for such issues, and a doctor\’s diagnosis is required.
2. Holding urine for too long during daytime can lead to bladder control problems, which could lead to bedwetting in children. This could be the reason for the sudden onset of bedwetting.
3. Secondary bedwetting might also happen due to an underlying medical condition, such as diabetes, urinary tract infections, and constipation. These conditions can increase the number of times the child urinates during the day and night.
4. Anxiety and stress can sometimes trigger secondary bedwetting in adolescents. If not dealt with early on, it could become a problematic habit. As bedwetting, in turn, causes stress, blaming or reprimanding the child may only worsen the situation.
5. If your children have caffeinated drinks before going to bed, chances are they\’ll end up with a full bladder before the night is over.
6. Irregular bowel movements can put pressure on the rectum, thereby might interfere with the nerve signals between the bladder and the brain.
7. Sometimes, children start bedwetting suddenly if they were victims of sexual abuse, look for other signs such as repeated urinary tract infections, vaginal pain, and unusual discharge.
8. Abnormalities in the nervous system may cause neurological problems that may have Enuresis as a side effect.

Home Remedies for Bedwetting Or Enuresis In Children

If your child isn\’t especially bothered or embarrassed by an occasional wet night, lifestyle changes — such as avoiding caffeine entirely and limiting fluid intake in the evening — may work well. However, if lifestyle changes aren\’t successful or if your grade-schooler is terrified about wetting the bed, he or she may be helped by additional treatments.

If found, underlying causes of bedwetting, such as constipation or sleep apnea, should be addressed before other treatments.

Options for treating bedwetting may include moisture alarms and medication.

• Limit fluids in the evening. It\’s important to get enough fluids, so there\’s no need to limit how much your child drinks in a day. However, encourage drinking liquids in the morning and early afternoon, which may reduce thirst in the evening. But don\’t limit evening fluids if your child participates in sports practice or games in the evenings.
• Avoid beverages and foods with caffeine. Drinks with caffeine are discouraged for children at any time of day. Because caffeine may stimulate the bladder, it\’s especially discouraged in the evening.
• Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it\’s OK to use the toilet during the night if needed. Use small night lights, so your child can easily find the way between the bedroom and bathroom.
• Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate every two hours or so, or at least often enough to avoid a feeling of urgency.
• Prevent rashes. To prevent a rash caused by wet underwear, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a protective moisture barrier ointment or cream at bedtime. Ask your pediatrician for product recommendations. 
• Massage: Massaging the lower abdomen with olive oil might prevent involuntary flexing of the pelvic muscles that result in bedwetting. Warm the olive oil a little, massage the lower abdomen with the warm oil, and massage every day for the best results.
•  Bladder exercises: A few exercises might help in strengthening the muscles of the urinary tract and stretch them to prevent bladder contraction. Holding the pee for 10-20 minutes longer (while having the urge to pee) might help expand the bladder and improve control, but make sure the child does not do it to postpone peeing. Another Kegel exercise is to hold and squeeze a small ball (the size of a fist) between the thighs (just above the knees) might strengthen the pelvic muscles. Exercising the pelvic muscles at least twice a day to make it stronger and improve bladder control.
• Cinnamon: Cinnamon has antioxidant properties and also keeps away diabetes. If the bedwetting is caused due to a bacterial infection or diabetes, a dose of cinnamon every day might help. Give the child a piece of cinnamon to chew every day. Also, use cinnamon powder as topping on milk, desserts, or bread.
• Cranberry juice: Cranberry might be useful to treat urinary tract infections, but further studies are needed to prove this. However, you might try giving cranberry juice to your child if the bedwetting is due to urinary tract infections.
•  Walnuts and raisins: Walnuts and raisins might help in reducing the symptoms of bedwetting. Give the child a light snack of three almonds and two raisins before he goes to bed. Repeat this every day for a few months until there is significant progress, and the dry spells are longer.
•  Honey: Giving one small teaspoon of honey for a younger child and one tablespoon for a teen could help reduce the bedwetting.

Parental Attitude

The parents\’ attitude toward the bedwetting is all-important in motivating the child.

• Focus on the problem: bedwetting. Avoid blaming or punishing the child. The child cannot control the bedwetting, blaming, and punishing just makes the problem more daunting for all.
• Be patient and supportive. Reassure and encourage the child often. Do not make an issue out the bedwetting each time it happens.
• Enforce a \”no teasing\” rule in the family. No one is allowed to tease the child about the bedwetting, including those outside the immediate family. Do not discuss the bedwetting in front of other family members.
• Help the child understand that the responsibility for being dry is his or hers and not that of the parents. Reassure the child that you want to help the child overcome the problem. If applicable, remind him that a close relative successfully dealt with this same issue.
• The child should be included in the clean-up process.