Enuresis is a child’s involuntary release of urine at an age when he or she should be able to control urinary function. Usually the child is around age 5 or 6. Enuresis can occur during the day, referred to as diurnal enuresis. More commonly, enuresis occurs at night, which is called nocturnal enuresis or bedwetting. Enuresis is a normal part of development and most children outgrow it. Enuresis rarely has an underlying physical cause.
Nocturnal enuresis is categorized into two types. A child can either have primary nocturnal enuresis, in which he or she has never learned to control his or her bladder functions and eventually outgrows the bedwetting. Or a child can have secondary nocturnal enuresis, in which he or she has learned bladder control but develops enuresis again after 6 months of staying dry.
Enuresis is not painful; however, it can embarrass children, create anxiety, diminish self-esteem, and prevent children from developing social relationships.
Because nocturnal enuresis is involuntary, the child should never be punished.
WHAT ARE THE SYMPTOMS?
Nocturnal enuresis is neither a condition nor an illness; therefore, it has no symptoms.
CAUSES AND RISK FACTORS
The majority of children who wet the bed at night are physically healthy and emotionally sound. Although physicians do not know a definitive cause, they have many theories to explain the primary nocturnal enuresis, including:
- Delay in physical development; and
- Low levels of arginine vasopressin.
Causes of secondary nocturnal enuresis may include:
- Overactive bladder;
- Anxiety or stress.
Approximately 1 percent of enuresis cases may be caused by a physical problem such as:
- Urinary tract infection;
- Constipation;
- Neurogenic bladder;
- Obstructive sleep apnea;
- An obstruction in the urethra or ureter;
- Diabetes mellitus;
- Diabetes insipidus;
- Heart block; or
- Hyperthyroidism.
In these cases, nocturnal enuresis may be a symptom of the underlying condition or disorder.
Children are at greater risk for enuresis if their parents also experienced enuresis as a child. Generally, children will stop wetting the bed at night around the same age that their parents stopped.
DIAGNOSIS
The physician will conduct a history and physical examination. He or she may instruct the parents and child to keep a voiding diary for 1 to 2 weeks.
If the physician suspects that the bedwetting may be caused by an underlying condition or illness, he or she may order a urinalysis or an x ray. Other tests that may be performed include:
- Voiding cystourethrogram (VCUG);
- Cystoscopy;
- Magnetic resonance imaging (MRI);
- Urine flow study; or
- Electrocardiogram (ECG).
TREATMENT APPROACH
Nocturnal enuresis is usually not considered a problem until the child reaches the age when he or she should be able to control urination, usually around age 5 or 6. If the physician decides that a treatment approach is necessary, he or she may begin with behavior modification techniques, such as:
- Alarm therapy;
- Bladder training; or
- Responsibility reinforcement.
For children who do not improve with behavior modification after 1 month, the physician may recommend one of the following medications:
- Desmopressin acetate (DDAVP);
- Imipramine; or
- Anticholinergic therapy.
