Enuresis

What is enuresis?

Enuresis (say "en-yur-ee-sis") is the medical term for bed-wetting during sleep. Bed-wetting is fairly common among children and is often just a stage in their development. Bed-wetting is more common among boys than girls.

What causes bed-wetting?

A number of things can cause bed-wetting. Some of the more common causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Stress
• Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night)
• Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• A small bladder

Bed-wetting is not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom.

When do most children achieve bladder control?

Children achieve bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to 6 years of age is not unusual, even though it may be frustrating to parents. If a child is younger than 6 years of age, treatment for bed-wetting usually is not necessary.

How can my family doctor help?

Although most children who wet the bed are healthy, your doctor can help you determine whether your child’s bed-wetting is caused by a medical problem. First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes.
Your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home.

What are the treatments for bed-wetting?

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:

• Limit fluids before bedtime.
• Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
• Use an alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
• Create a reward system for dry nights.
• Ask your child to change the bed sheets when he or she wets.
• Bladder training: have your child practice holding his or her urine for longer and longer times during the day, in effort to stretch the bladder so it can hold more urine.

What kinds of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

How can I help my child cope with wetting the bed?

Bed-wetting can lead to behavior problems because a child may feel guilt and embarrassment. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem.
It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).
Remind your child that it's okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child's mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

Source

Primary Nocturnal Enuresis: Current Concepts by M Cendron, M.D. (American Family Physician March 01, 1999, http://www.aafp.org/afp/990301ap/1205.html)

Written by familydoctor.org editorial staff

Reviewed/Updated: 07/10
Created: 03/99

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