Urology :: Bedwetting (Nocturnal Enuresis)
What is Nocturnal Enuresis?
Nocturnal enuresis is the medical term for bedwetting. Incontinence is urination that occurs at an unintended time. Nocturnal enuresis may be diagnosed in children who are developmentally over the age of 6 and are still wetting the bed at night. There are different types of bedwetting that may occur, including the following:
- Primary nocturnal enuresis
A child that has never had a 6 month period of dryness at night.
- Secondary nocturnal enuresis
A child who has been dry at night for over 6 months at some point in their life but who is having accidents at night again.
What are some key facts about nocturnal enuresis?
• Nocturnal enuresis occurs three times more frequently in boys than in girls.
• Primary enuresis is the most common form of urinary incontinence among children.
• It is estimated that nearly 25% of school-aged children have some form of incontinence.
• If a parent had nocturnal enuresis as a child, there is a higher chance that their children will as well.
• Nocturnal enuresis is very rarely an intentional act by a child. Normally the child is unable to control the urination at night and are unaware that they are urinating.
What causes urinary incontinence?
There are many factors that may be involved, and many theories that are given for why children wet the bed at night. The following is a list of some of the possible reasons for the problem:
- Maturity of a child’s bladder function.
- Small bladder capacity.
- Poor sleep habits or the presence of a sleep disorder.
- Medication that affects sleep.
Commonly the cause behind why a child is wetting at night is not determined. The communication between the bladder and the brain that works during the day to let a child know when they need to use the restroom is not functioning in the same manner at night. This is a process that improves as a child ages, but can take into teenage or adulthood to occur in some individuals.
It is important to remember that nocturnal enuresis is very rarely an intentional act by a child. Normally the child is unable to control the urination at night and is unaware that he or she is urinating.
How is nocturnal enuresis diagnosed?
Nocturnal enuresis is diagnosed based on a complete medical history and physical examination of the child. In addition to talking with the child’s caregivers and the child, our pediatric urology specialists may perform the following to help rule out other causes for the wetting:
- Urine tests (to make sure there is not an underlying infection, or condition such as diabetes).
- Voiding diaries to better understand the size of a patient’s bladder.
- Renal ultrasound to look for a physical anomaly in the urinary system.
- Uroflow and post void residual tests.
- KUB to look for constipation.
What is the treatment for urinary incontinence (enuresis)?
Specific treatment for enuresis will be determined by our pediatric urology specialists based on:
- The child's age, overall health and medical history.
- Extent of the condition.
- The child's tolerance for specific medications, procedures or therapies.
- Expectations for the course of the condition.
- The family’s opinion or preference.
Prior to starting treatment, it is important for caregivers to understand that it is not the child's fault and that he or she should never be punished. Children cannot control their bed wetting. According to the American Association of Pediatrics (AAP), enuresis usually goes away on its own in about 15 percent of affected children each year. It is estimated that nearly 1 in 4 school-aged children have some degree of incontinence, and is very common.
Treatment may include:
- Positive reinforcement of the child (i.e., the use of sticker charts for dry nights).
- Use of night-time alarms to help tell the child wake up while they are urinating.
- Prescribed medications to help control the wetting for sleep-overs and vacations.
- Decreasing fluids and avoiding caffeine at night (if the child has properly hydrated during the day). Learn more about the amount of water children should consume each day.
- Medications may be recommended if the child’s bladder is found to be small for his or her age.
- Management of constipation or poor water intake.
In addition, counseling for the child and family may help to determine any stress the child may be under and can be beneficial.