Nocturnal Enuresis / Bedwetting

Nocturnal Enuresis - Introduction

Nocturnal enuresis (NE), also known as "bedwetting” or "sleep wetting," is described as the involuntary passing of urine during sleep after the age at which bladder control would normally be anticipated.

"Nocturnal" means that this happens at night and "Enuresis" is an inability to control the flow of urine. It's common for toddlers to wet the bed, as they have not yet learned to control the flow of urine efficiently. However, nocturnal enuresis can be a trouble for older children too.

Nocturnal enuresis occurs on most nights in 15% of five year olds and is still a problem for up to 3% of 15 year olds. A child may wet the bed one or more times per night, and may sometimes have problems staying dry during the day, too. It's not an illness, but a condition that can be treated effectively and permanently.

Types Of Nocturnal Enuresis

There are two types of nocturnal enuresis – primary nocturnal enuresis and secondary nocturnal enuresis. Primary nocturnal enuresis is when a child has never developed complete nighttime 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 connected with a period of emotional stress such as the birth of a younger sibling, a sadness or school worries.

Causes Of Nocturnal Enuresis

Urine is stored in the bladder, which stretches like a balloon as it fills up. The nerves in the bladder wall send a message to the brain saying that it wants to be emptied, when it stretches to a certain point.

Urine passes out through the urethra. The bladder empties anyway, if a child is asleep and the brain does not "hear" this message. The causes of nocturnal enuresis are unknown, but some factors are linked to it.

• Heavy sleeping - most doctors don't believe this alone can cause bedwetting, but in some cases it may play a role.
• 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.
• 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.
• Inherited aspect - children whose parents used to wet the bed are more likely to do so themselves.
• Bladder size - bedwetting may be related to a small bladder size.
• Constipation - this can lead to leakage of urine.
• Diet - dairy products, citrus fruits, chocolate and foods containing high levels of artificial colour and sweetener have been connected with bedwetting.
• Infection - an infection in the bladder or kidneys may cause bedwetting.

Nocturnal Enuresis Signs and Symptoms:

Nocturnal enuresis is usually defined as the uncontrolled loss of urine during sleep after the age of 5 years. It is known to cluster in family groups. If one or both parents have had trouble with bedwetting, their children have an increased chance of having similar problems. It is more common in boys than girls.

There is a gradual reduction in the number of children who are wet at a rate of about 15 percent per year, as children grow up. An inadequate production of a hormone that decreases urine output during sleep may be the cause in some children.

This hormone, called antidiuretic hormone (ADH), occurs naturally in all of us and is responsible for concentrating urine if we become dehydrated. This hormone is not related to sex hormones. Secretion of this hormone is normally high at night.

Nocturnal Enuresis Diagnosis

Parents bothered about nocturnal enuresis can check with their general physician. During the visit, the doctor will ask about parental or sibling bedwetting, earlier urinary tract troubles, and establishment of toilet training and daytime control.

The physical examination will include careful assessment of the abdomen and genitalia, and a neurologic exam of legs and perineum to determine sensation and adequate motor development.

Most children will only need a general physical examination, and will have their urine tested with dipsticks. It is rare that a child who wets the bed has any underlying illness. However, other possible problems such as diabetes, abnormalities or infections will need to be ruled out.

Nocturnal Enuresis Treatments

Nocturnal enuresis treatment is not usually needed for children under six, because in most children, it will make their mind up spontaneously. Nocturnal enuresis treatment options include:

Enuresis Alarms

A child who wets the bed needs to build up 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 enuresis alarms also vibrate, which is useful for children with hearing impairments or those who sleep in a room with others. It is not generally 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. Enuresis alarms are efficient 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.

Tips For The Parents:

Tips for a dry night:

• Make sure your child visits the toilet just before going to bed. Parents sometimes lift a sleeping child to the toilet before they themselves go to bed. However, this may encourage a child to wet the bed because their bladder does not feel full before they pass urine.
• Record wet and dry nights.
• Encourage your child to return to her own bed after it has been changed.
• Make sure your child doesn't have a drink within two to three hours of bedtime. However, limiting a child's fluid intake during the day will not help to develop bladder control. Make it easy for your child to reach the toilet.