While we sleep, our brain normally manufactures and releases a hormone that reduces the amount of urine we produce. This hormone, called vasopressin, is an antidiuretic (anti - for against, and diuretic for making extra urine).
Some researches theorize that when we lie down to sleep, our body's blood pressure temporarily increases. To counteract this effect, our body decreases its production of vasopressin (which bring the blood pressure back down), and as a result more urine is produce for a brief time. In children who already lack sufficient vasopressin, this explanation would account for why they may wet about one half hour after they go to sleep, even if they used the potty just before bed.
Some children with enuresis release less vasopressin than normal, according to one group of researchers. The obvious conclusion is that some children wet at night because they produce more urine than their counterparts who do not wet. However, if such children are taking too much urine, why don't they wake up when their bladder is full? Expert still don't have a definite answer to this question, other than the seeming association between deep sleep and bedwetting.
Diabetes
Many parents whose children drink and urinate a lot worry about diabetes mellitus, a disorder in which the body does not process food well, especially sugar, so that sugar accumulates in the bloodstream. If there is too much sugar in the blood, the kidney will make more urine, so the person with diabetes ends up drinking more to compensate for extra urination. Your doctor can preform a routine test for sugar in the urine to see if this unusual disorder may account for bedwetting in your child.
Another type of diabetes is diabetes insidious. In this condition, the pituitary gland, located in the center of the brain, delivers too little of a particular hormone to the bloodstream. When the kidneys don't receive enough hormones, they do not retain water and therefore, produce excess urine. Wetting can result. If you suspect that your child may be diabetic, be sure to have your doctor preform a through examination before undertaking this or any other dryness program.
Sickle Cell Disease
Children suffering from sickle cell disease may be prone to bedwetting problems. With this disease, normally smooth, dislike red blood cells may transform into sickles or crescents if there is a reduction in the amount of oxygen in the blood. Because the center of the kidney has low oxygen content, the sickle cells move sluggishly in the blood vessels. Since sickle cells move sluggishly in the blood vessels, the central section of the kidney may lose their viability. Overtime, this disorder may reduce the kidney's ability to concentrate urine. As a result, children may pass large amount of urine while sleeping even if they have not drunk much liquid.
Like children with vasopressin deficits, children with sickle cell disease may also bed wet. But why doesn't the full bladder wake them up? again, perhaps deep sleep is the cause. But in the bright side children with sickle cell disease who bed wet have successfully stopped wetting by using an enuresis alarm, without resorting to supplementary hormone medicine to concentrate the urine.
Urine Infection
Although children may develop a urine infection because of a malformed urinary tract, most urine infections result from simple causes such as following poor hygiene (washing the genitals inadequately) or delaying using the bathroom. Children also get urine infections when their body's defenses are down, say when they have gotten over a cold.
Children with urine infections usually express great urgency to urinate and may need to do more often than usual. They will literally run to the bathroom, several times an hour. They might not get to the bathroom in time, so they may wet by day as well as by night or both, Here are some other signs to look for:
- Fatigue and irritability
- Painful urination
- Bloody or cloudy urine with a strong or foul odor
- Back pain
- Fever
- Bed sheets even wetter than usual
- Day urgency or wetting, or both, in a child who already bed wets (when not infected)
Here is how this increased urgency may happen. Urine infections can weaken the bladder function of holding and expelling urine. The infection inflames the bladder wall, making the normally soft muscle stiff, and so likely distends poorly, when the signal to void comes, the bladder contracts too quickly and urgently. A bladder contraction may immediately follow the urge, making children wet before they can get to the potty.
Antibiotics usually heal urine infection, but the wetting may not stop even though the infection is gone. Some children who have show this patten of urgency and wetting during infections, for some reason not yet really understood, may continue to show small capacity, urgency, and wetting weeks or months after the infection is gone. Once this cycle of wetting has begun, it seems that urine moisture in the genital skin and clothing fosters the growth of new bacteria, which can penetrate the body's defenses and cause yet another urine infection, repeating the cycle of infection and wetting. This situation can get even more complicated for some children who not only hold their urine back, but also come to hold their stool back, causing constipation, irregular defecation, or both.
Attention Deficit Hyperactivity Disorder
Ten percent of children with nighttime enuresis have attention deficit hyperactivity disorder (ADHD), and 25 percent of children who have ADHD may be so overwhelmed by social and school problems related to the disorder that the wetting components just does not seem very serious. Parents tend to focus, understandably, on finding an affective remedy for the ADHD, and put aside their concerns over the wetting. However, once the ADHD treatment begin to show success, parents may be disappointed to find that the wetting persists. Families need to understand that the therapies aimed at ameliorating ADHD will not necessarily solve a wetting problem.
Although the reason for the association between ADHD and enuresis is unclear, in our experience it appear that children with ADHD, particularly those with daytime wetting, do not pay attention to their internal bladder cues. They are so distracted and reinforced by whatever else they are going, watching television, playing outside, building blocks, that they just don't stop and think about that they should get up and go to the bathroom when they need to. Children with ADHD can't tear themselves away from the fun activity, which is immediately gratifying. Some children say that they initially feel the urge to use the potty and get distracted. Other seem insensitive to the fullness of their bladder.
Some children with ADHD have so much trouble completing tasks, even the task of urinating, that when they do run and use the potty, they urinate incompletely, just long enough to relive the pressure. Then they go back to playing, only to find that they are wet a half hour later.
We recommend that enuretic children with ADHD receive treatment for their ADHD prior to the treatment for their bed wetting, because treating the ADHD first will make the likelihood of success with wetting program that much greater.
Other Sleep Disorders
Some children may have other medical problems that may cause them to sleep poorly, which can in turn affect their ability to stay dry through the night. One common problem among children is enlarge or inflamed tonsils. In some cases, large tonsils can restrict airflow, possible causing the child's brain to get too little oxygen. Its reasonable to believe that this lack of oxygen to the brain can impair the brains performance and the child's ability to control normal bodily functions, including bladder control, during sleep.
Restricted airflow can lead to intermittent stopped breathing called apnea. Aside from enlarge tonsils and adenoids, apnea can be caused by a number of other conditions. Symptoms of apnea might include irregular or noise breathing, snoring, and teeth grinding, along with morning headaches and excessive morning thirst. Your child should be evaluated by a physician if her or she knows any of the symptoms associated with sleep apnea.
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