This page contains information on enuresis which I
pulled off the web. Authors and sight address included when available.
What is enuresis?
Enuresis (say: "en-yer-ee-sis"} is the medical term for bed-wetting. This term applies to children who wet the bed only at night when they're sleeping, not during the day.
“Enuresis" is an inability to control the flow of urine, and "nocturnal"
means that this happens at night. The usual definition of nocturnal
enuresis is bedwetting over the age of five years.
It's common for toddlers to wet the bed, as they have not yet learned to
control the flow of urine effectively. However, bedwetting can be a
problem for older children too.
A child may wet the bed one or more times per night, and may sometimes
have problems staying dry during the day, too. Betwetting occurs on most
nights in 15% of five year olds and is still a problem for up to 3% of
15 year olds. It's not an illness, but a condition that can be treated
effectively and permanently.
There are two types of nocturnal enuresis. Primary nocturnal enuresis is
when a child has never developed complete night-time bladder control.
Secondary nocturnal enuresis is when a child has accidental
wetting after having had bladder control for six or more months. It's
often associated with a period of emotional stress such as the birth of
a younger sibling, a bereavement or school worries.
The exact cause of most bed-wetting is not known. Many factors are
involved. In some children, the cause may be genetic (bed-wetting tends
to run in families). In other children, nighttime bed- wetting may occur
because more urine is produced during sleep. Another cause of
bed-wetting may be a small bladder and its inability to hold urine for a
long time.
A less common cause of bed-wetting may be a problem with the bladder,
the kidneys or the nervous system. Deep sleep is not thought to be a
cause of bed-wetting. Emotional stress usually is not a cause, but it
may be for a child who has had full bladder control for a long time and
then starts wetting the bed again. Most of the time, bed-wetting is not
a sign of illness, stress or a mental problem. Your doctor can help you
decide if your child needs special testing.
Why does bedwetting happen?
Urine is stored in the bladder, which stretches like a balloon as it
fills up. When it stretches to a certain point, the nerves in the
bladder wall send a message to the brain saying that it needs to be
emptied. Urine passes out through the urethra. If a child is asleep and
the brain does not "hear" this message, the bladder empties anyway.
The cause of bedwetting is unknown, but some factors are linked to it.
Bladder size - bedwetting may be related to a small bladder size.
Inherited aspect - children whose parents used to wet the bed are more likely to do so themselves.
Infection - an infection in the bladder or kidneys may trigger bedwetting.
Constipation - this can lead to leakage of urine.
Antidiuretic hormone - children who wet the bed may have a lower level of a hormone called antidiuretic hormone, which suppresses the rate of urine production. This means they may make more urine than most people do at night.
Delayed growth and development - some children’s nervous system is not mature enough to be able to sense when the bladder is full.
Heavy sleeping - most doctors don't believe this alone can cause bedwetting, but in some cases it may play a role.
Diet - dairy products, citrus fruits, chocolate and foods containing high levels of artificial colour and sweetener have been connected with bedwetting.
Psychological and social factors - most often the cause of bed-wetting is not related to emotional problems. However, some children who wet the bed tend to be less mature and self-reliant than those who do.
What is the best treatment for bed-wetting?
Your child should be seen by your family doctor to see if special
testing is needed. If your child is healthy and no reason for the
bed-wetting is found (this will be the case about 90% of the time), your
doctor may suggest a few different treatments. Some of these treatments
are listed below:
Treatment is not usually needed for children under six, because in most
children, it will resolve spontaneously.
Treatment options include:
A child who wets the bed needs to develop a better response to a full
bladder, and an enuresis alarm can be an effective way to do this. When
the child starts to wet the bed, a moisture sensor sends a signal to a
control panel, which sounds an alarm. Some alarms also vibrate, which
is useful for children with hearing impairments or those who sleep in a
room with others.
As well as waking the child, who gets up to go to the toilet, the alarm
stimulates the child's pelvic floor muscles to contract and so control
the flow of urine. Gradually the child is conditioned to wake before the
alarm sounds - or to sleep through the night without needing to
urinate - and should start to achieve dry nights.
It is not usually recommended that children start using alarms till
they are six or seven. They need to be old enough to understand the
problem and how they have a part to play in treating themselves.
Alarms are effective in about 70% of children, but in 10-15% bedwetting
returns. Continuing to use the alarm for at least three weeks after the
child's last wet night can reduce the chance of this happening. A child
will usually need an alarm for between three and five months.
Alarms may be bought or hired from the local community health/child
guidance service - a specialist incontinence nurse may be available to
give advice.
Medications can work more quickly than alarms to treat bedwetting, so
may be useful to help a child to build up confidence, especially if he
or she is going on a school trip or sleepover. However, medication only
manages the problem in the short term rather than curing it.
A desmopressin nasal spray is usually effective in the short term. It
works by making the child produce less urine. It works quickly and
produces few side-effects. One puff is given to each nostril before bed.
Desmopressin tablets are also available.
A drug called imipramine, which is used as an antidepressant in adults,
may help by improving the child's sleep patterns or affecting the way
the bladder muscles of the bladder work. However, it should not be used
for more than three months. There may be side-effects such as changes in
behaviour. It can be fatal in overdose and must be stored out of
children's reach.
Some children who have daytime wetting as well may be diagnosed as
having an "overactive bladder". This results in the bladder contracting
even though it’s not full. A drug called oxybutynin may be helpful for
this particular type of enuresis.
It is possible to use drugs and an alarm at the same time. Scientific
evidence suggests that more children become dry after using the alarm
with drugs, compared to the alarm alone.
There is some scientific evidence to suggest that ultrasound treatment
and electro-acupuncture may help, but these need more investigation
It's best to talk openly to your child about the problem. Give
reassurance that he or she is not ill and that this problem can be
solved. Praise all signs of improvement and all your child's efforts to
conquer the problem. Do not blame, criticise or punish your child or
call them dirty or babyish.
Tips for a dry night
There are a number of specialist products available to keep beds dry,
such as plastic mattress covers and dry-pants (mini-nappies). An
enuresis nurse can offer advice, as can the organisations below.
No. Punishing your child for wetting the bed will not solve the problem.
Your child doesn't wet the bed on purpose. He or she needs your love
and support. You may feel frustrated at times, but your child may be
too. Asking your doctor for help will be better for both you and your
child.
Further information
Enuresis Resource and Information Centre (ERIC)
The Continence Foundation
Enuresis
FamilyDoctor.com
0117 960 3060
http://www.enuresis.org.uk
0845 345 0165
http://www.continence-foundation.org.uk