Bed wetting (nocturnal enuresis)

By Dr Lemma

I would like to disclose that I am not an expert in the field but I thought it would be worthwhile to post a short summary. 

Bed wetting: also called nocturnal enuresis is defined as incontinence episodes while asleep. Most children acquire full continence by the age of 3-4 years. A child has to be at least 5 years old before one can make the diagnosis of bed wetting. Although variable, bed wetting is seen in around 5-10 % of school age children. It is more common in boys than girls. Fortunately most children grow out of it with out requiring any therapy.

Bed wetting that happens with out day time urinary symptoms is called monosymptomatic and is usually difficult to find the exact cause. However when it is accompanied by day time urinary symptoms like an urge to void, frequent urination and dribbling, it is usually related to bladder dysfunction. Most of the information below applies to the form of bedwetting with out day time urinary symptoms (monosymptomatic)

Studies have showed that up to 20-40% of children with urinary incontinence present with behavioral disorders which can precede or follow the onset of bed wetting.

Possible causes of bed wetting:

-impaired perception of bladder fullness during sleep

-imbalance between bladder capacity and urine production at night

-impaired antidiuretic hormone secretion at night (anti-diuretic hormone helps the kidney to reabsorb water)

-possible underlying psychological problems (could contribute to return of symptoms) (could also be a result of bed wetting)

-abnormal bladder function especially in those with day time urinary symptoms

Treatment options in bed wetting: main method of therapy is behavioral and not medication.

  • Behavioral treatment: needs motivated parent and child.

-Drinking, sleeping and urinating habit:

-learn to urinate when there is the urge to do so

-scheduling urination before bed and in the morning

-limiting fluid intake within 2 hours before going to bed (make sure the child gets enough fluids during the day)

-Alarm therapy: the child will sleep with alarm that has sensor which is turned off(rings) with moisture/bed wetting. This will wake up the child and eventually train the child to wake up before bedwetting. It takes several nights before it works but is usually successful in half to 2/3 of cases.

  • Medications:

-usually temporary solution

-problem comes back when the medication is stopped

-useful in situation where short term control is needed

  • It is important to look for and treat any co-existing psychosocial/behavioural problem.

References:

1. Ertan et al. Relationship of sleep quality and quality of life in children with monosymptomatic enuresis: 2009 Blackwell Publishing Ltd, Child: care, health and development, 35, 4, 469–474. 

2. Naseri M, Hiradfar M; Monosymptomatic and Non–monosymptomatic Nocturnal Enuresis: A Clinical Evaluation. Archives of Iranian Medicine, Volume 15, Number 11, November 2012. 

3. Lampel et al. Urinary incontinence in children: Dtsch Arztebl Int 2011; 108(37): 613–20. 

4. Gontard, Does Psychological Stress Affect LUT Function in Children? Neurourology and Urodynamics 31:344–348 (2012).

Dr Lemma went to medical school in Jimma. He studied Hematology and Oncology at the Karmnos Cancer Center/ Wayne State University in Detroit, MI.

About Tenayistilign

I am a physician trained at Jimma Institute of Health Sciences ( now Jimma University, in Jimma, Ethiopia) and Wayne State University ( Detroit, MI, USA). I teach and practice General Nephrology/Hypertension and Kidney Transplantation in the USA.
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