Nocturnal enuresis, more typically known as bedwetting, is characterized by involuntary urination during sleep in individuals aged 5 and over. It is a very common occurrence in children, with 15% of 5 year olds and 5% of 10 year olds wetting the bed. However, bedwetting tends to spontaneously resolve as children get older. The prevalence of bedwetting in adulthood is approximately 0.5%-1%. Bedwetting in both childhood and adulthood can have a profound impact on a person’s behavior, emotional well-being and social life.
There are two different categories of bedwetting, termed “primary” and “secondary” bedwetting. Primary bedwetting refers to children who have yet to stay dry for at least 6 months. Secondary bedwetting occurs when an individual reverts back to nighttime wetting after an extended period of dryness (at least 6 months).
There are many causative factors associated with bedwetting. With primary bedwetting, there is often a genetic influence. Studies have shown that if both parents experienced bedwetting, then the child will have a 77% chance of bedwetting. If one parent experienced bedwetting, then the child will have a 44% chance of bedwetting. Children born to parents who did not wet the bed will only have a 15% chance of bedwetting. The dominant gene associated with bedwetting is thought to be located on chromosome 13. Another accepted cause of primary bedwetting is delayed maturation of the central nervous system, which reduces the child’s ability to inhibit bladder emptying at night. Primary bedwetting may also be caused by impaired function of antidiuretic hormone. Normally, antidiuretic hormone is secreted during sleep in order to reduce urine production in the kidneys, thus decreasing the amount of urine stored in the bladder. However, in some children that experience bedwetting, antidiuretic hormone secretion is reduced at nighttime, thereby resulting in urine overproduction during sleep. Causes of secondary bedwetting include neurogenic bladder, urinary tract infections, diabetes and psychological conditions such as stress, anxiety and attention deficit disorder.
If an individual is experiencing bedwetting then a doctor should be consulted. A medical history and physical examination will allow the doctor to make a diagnosis. The physical examine will involve abdominal, genital and neurological tests to assess for distended bladder, epispadias or spinal injury. Urine samples may be obtained to test for diabetes or urinary tract infections. In some cases, psychosocial and family histories are taken to rule out potential psychological or behavioral issues.
A wide range of treatments are available for bedwetting. The first treatment approach often involves maintaining a diary and providing a reward for each night the child manages to stay dry. Bedwetting alarms have been proven useful in some cases, whereby a moisture-detection pad is placed underneath the child during sleep. When the pad detects moisture it emits a sound which triggers the child to awaken. This eventually conditions the child into waking when their bladder is full. A similar method is for the parent to wake the child every 2-3 hours throughout the night and encouraging them to go to the bathroom. If bedwetting persists, there are some medications available to treat bedwetting. One pharmacological approach is to use anticholinergic drugs, which decrease the bladder’s ability to contract. However anticholinergics can have side effects such as constipation, drowsiness and dizziness. If bedwetting is caused by a lack of production of antidiuretic hormone, a synthetic version of antidiuretic hormone called desmopressin can be prescribed.
Author: Dr. Emma Mitchell, PhD, UK – Review Board
Reviewed Feb 2016
TEK, M. & ERDEM, E. 2014. Advances in the management of enuresis. F1000Prime Rep, 6, 6-106.
SARICI, H., TELLI, O., OZGUR, B. C., DEMIRBAS, A., OZGUR, S. & KARAGOZ, M. A. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. Journal of Pediatric Urology.
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Bedwetting (also called enuresis) is sometimes classified as a parasomnia- any of a number of sleeping related disorders that cause undesired or unconscious action while asleep; in this case uncontrollable urination while asleep. Bedwetting is a common problem among children who have not yet fully mastered control of their bladder, but can also carry on or begin later in life.
Bedwetting is defined as uncontrollable urination in individuals who are expected to have developed bladder control by that point. Babies naturally are not considered bedwetters. The age at which bladder control should be expected can vary. Many parents believe it is around 3 years old, and tied to their toilet training development, though these may be unrelated. Physicians more liberally believe that 5 years old is a fair age to expect full bladder control, including control while sleeping.
Bedwetting on a rare basis is not considered serious, though it could have the same psychological effects. The general consensus is that wetting the bed twice a week on average classifies it as a sleep disorder.
Bedwetting is further broken down into primary and secondary bedwetting. Primary bedwetting refers to children who have yet to stay dry, meaning they have been bedwetting their whole lives. Secondary bedwetting includes people who were dry at one point (this does not necessarily mean they were not bedwetting, just not a rate to classify it as such), but have recently begun doing it a rate serious enough to classify it as bedwetting. Secondary bedwetting is often caused by stress or bladder conditions.
Bedwetting decreases rapidly as children get older, whether through treatment or naturally. As many as 20% of children aged 5 years-old wet their beds, with just 5% of 10 year olds, and 1-2% of adults doing the same. Studies have demonstrated that adults are unlikely to experience a spontaneous resolution of bedwetting, and will often need treatment to remedy it.
There are two main processes that develop to prevent bedwetting; the most obvious is the ability to sense and wake up when the bladder is full. The other is a hormone burst that reduces the production of urine in the kidney, decreasing the chances of a full bladder during sleep. Most children develop this by the age of 5, but some may not develop until their teen years, or not at all.
The causes of bedwetting are many. Genetics plays a strong role. Children born to parents who did not wet their beds will have only a 15% chance of doing so themselves. Children born to parents who both wet the bed are 5 times more likely to also wet the bed, at a rate of 77%. Infections or diseases, namely urinary tract infections can cause bedwetting. This falls under secondary bedwetting, and resolves when the condition is resolved. Physical abnormalities are the cause of some bedwetting cases. This can include decreased bladder size. Finally, production of the above mentioned hormone can increase the risk of bedwetting, especially in children who have not yet developed the ability to wake up upon bladder filling. Children with attention deficit disorder are 2.7 times more likely to have bedwetting problems as well, which may indicate the need for well developed mental faculties to control bedwetting. Other causes can include too much caffeine intake, stress, constipation, and deeper rooted psychological issues.
The psychological effects that bedwetting can have on children are strong. How parents deal with their children’s bedwetting will further dictate the child’s emotional state concerning it. Parents should be supportive and understanding of the problem, realizing that it is entirely sub/unconscious. Bedwetting can hamper a child’s self esteem, and limit their desire to engage in overnight stays with friends, or go on camping or other overnight trips where they’ll be in a room or bed with other people. They will likely endure humiliation from siblings or friends who are aware of the problem as well. Children with bedwetting ranked it as the 3rd most stressful event in their lives.
There are many available treatments for bedwetting. A doctor should first be consulted, and your child given an exam to try to determine the cause of the problem. This will help identify any physical causes. If none are found, an attempt can be made to find the underlying cause.
Behavior modification is a good step for eliminating the problem by enforcing positive routines in a child’s life that become second nature after extended use. Limiting a child’s intake of fluids when approaching evening hours is a simple and effective way to help limit bedwetting. Personally waking the child every few hours, or having them set an alarm to wake themselves and use the bathroom, is another option. Bedwetting alarms have demonstrated good results in conditioning children to recognize when their bladder is full. The alarm is a pad placed under the child as they sleep, and sounds at the moment of sensing moisture. This awakens the child, and conditions them to the feeling in their bladder at first waking.
Diapers can also be used to lessen a child’s embarrassment about bedwetting, but this is not a solution, and in fact may worsen its occurrences by making the child even less conscious of the events.
If the bedwetting is being caused by lack of production of antidiuretic hormone, the medication, desmopressin can be used.
Other medications exist to treat bedwetting, but these should be discussed with your doctor and based on your child’s medical history and other factors before being prescribed.
Reviewed September, 2007
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