Bedwetting, or ‘Nocturnal enuresis’, 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.
Two Categories of Bedwetting
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).
The Causes of Bedwetting
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 other bedwetting solutions 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.
Above Author: Dr. Emma Mitchell, PhD, UK – Review Board
Solutions to Bedwetting
What is Primary Nocturnal Enuresis (PNE)?
Primary nocturnal enuresis is the medical term for bedwetting. Bedwetting is a very common problem, and parents are often wondering how best to approach it for their child. While many parents report that their child wets the bed because he or she is a very deep sleeper, the validity of this has been debated. There is an association between children who wet the bed and those who spend more time in deeper stages of sleep but nonetheless, bedwetting can occur at any time during the night.
You’re not alone…
While the prevalence of PNE is approximately 13-16% in 5 and 6-year-olds, it decreases with age. By age 7-8, only 7-10% are bedwetters, and by age 10, only 5%. In teenagers, PNE is reported as low as 1-3%. It is more common in boys and is also highly genetic. You have approximately a 40-45% chance of having PNE if one parent had it and a 75% chance if both parents had it.
What are common misconceptions about PNE?
Although it is easy to want to blame your child, bedwetting is not your child’s fault and is not under his or her full control. It should never be punished. Bedwetting will often resolve without intervention, usually around the age a family member outgrew their bedwetting.
Bedwetting Treatment options for younger children
Most experts agree that children can start to be part of the treatment process at the age of 5. Parents can limit fluid intake after dinner, remind children to void (use the bathroom) before bed, and incentivize using the bathroom in the middle of the night by developing a reward system. Involving children in the cleanup process can help motivate them to use the toilet instead of wetting the bed by demonstrating that it requires more effort to clean up after themselves than to use the bathroom when they need to go.
Bedwetting Treatment options for older children
As children get closer to 7 or 8 years of age, a more definitive treatment approach can be added. While medications are sometimes used, we suggest they be used sparingly. Due to potential side effects and limited long term benefits, medications should be reserved for special occasions such as an overnight camp or a sleepover at a friend’s house. The enuresis bedwetting alarm is the most effective treatment for this condition when a child is motivated.
How does the Bedwetting alarm work?
The bedwetting sensor is attached to the child’s underwear, while the alarm is fastened to the child’s pajama top. When the sensor gets wet, the alarm goes off. Once this occurs, the child is encouraged to hold his or her urine in an attempt to finish voiding in the toilet. Over time, the brain learns to associate the contraction of the bladder sphincter with the alarm and ultimately the brain will contract the sphincter before wetting ever occurs.
Because you can start to see improvement within 2 weeks, children are often motivated to continue its use. Best outcomes are seen in children who have used the alarm for 3 successive months and achieved 21 consecutive dry nights. While older children and teenagers can be completely independent with the alarm, younger children might require the help of a parent at first. Ultimately, the bedwetting alarm has a 75-80% cure rate with regular use.
When should you call your doctor?
Consult your doctor if your child’s bedwetting is accompanied by any neurological signs such as weakness, numbness, bowel incontinence, or signs of infection such as fever or burning with urination. You should also contact your doctor if your child has a period of dryness of 6 months or more but then reverts back to bedwetting. If the bedwetting alarm goes off more than once a night, medication in conjunction with the alarm may be helpful. Always consult your doctor If there are any other signs and symptoms that seem concerning.
Authors: Cheryl Tierney, MD, MPH, Taylor Aves, Eugenia Gisin, Alexandra Lazzara, Megan Veglia
Cheryl Tierney, MD, MPH is a Board-Certified behavior and developmental pediatrician who has been in practice since 2002. She is a native of Brooklyn, New York and completed medical school at Tufts University in Boston. Her pediatric residency was at Carolinas Medical Center in Charlotte, North Carolina. She completed Fellowships in Health Services Research, where she received her MPH at Harvard School of Public Health as well as Behavior and Developmental Pediatrics in 2002. She is an active member of The Society for Developmental and Behavioral Pediatrics (SDBP) as well as the Academic Pediatric Association (APA). She enjoys participating in outdoor activities with her family.
President, ABA in PA INITIATIVE
Associate Professor of Pediatrics
Section Chief, Developmental Pediatrics, Penn State Hershey Children’s Hospital