Bedwetting (Nocturnal Enuresis)

What is bedwetting?

Bedwetting, also called nocturnal enuresis, is the involuntary passage of urine (urinary incontinence) while asleep. Inherent in the definition of bedwetting is satisfactory bladder control while the person is awake. Therefore, urination while awake is a different condition and has a variety of difference causes than bedwetting.

What are the types of bedwetting?

There are two types of bedwetting:

1. Primary enuresis: bedwetting since infancy
2. Secondary enuresis: wetting developed after being continually dry for a minimum of six months

What is primary bedwetting?

Primary bedwetting is viewed as a delay in maturation of the nervous system. At 5 years of age, approximately 20% of children wet the bed at least once a month, with about 5% of males and 1% of females wetting nightly. By 6 years of age, only about 10% of children are bedwetters -- thelarge majority being boys. The percentage of all children who are bedwetters continues to diminish by 50% each year after 5 years of age. Family history plays a big role in predicting primary bedwetting. If one parent was a bedwetter, the offspring have a 45% chance of a developing primary enuresis as well.

What is the basic problem in primary bedwetting?

The fundamental problem for children with primary bedwetting is the inability to recognize messages of the nervous system sent by the full bladder to thesleep arousal centers of the brain while asleep. In addition, bladder capacity is often smaller in bedwetting children than in their peers.

Is primary bedwetting due to emotional problems?

Parents sometimes believe that their child's primary bedwetting is emotional. No medical or scientific literature exists to support this impression.

How is primary bedwetting treated?

The "cure" for primary bedwetting is "tincture (or passage) of time." However, since many parents and children are frustrated with bedwetting as it starts to interfere with self-esteem or social events (for example, sleepovers), a patient step-by-step approach is best. Fortunately, it can be anticipated to have a successful outcome in over 75% of such patients. You should always discuss treatment options with your child's physician, since it is important to differentiate between primary and secondary enuresis prior to starting specific treatments.

It is also important to remember that different children develop differently and that primary enuresis can be a normal developmental stage. Toilet training a child requires special patience. While most children are fully toilet trained by 3-4 years of age, many will not stay dry overnight, even though they can during the day. Reassurance and encouragement often will work in time, but for some children, there are steps that can be taken to address the issues.

Some common recommended management and treatment options include the following:

1. Encourage voiding prior to bedtime, and restrict fluid intake before bed. 2. Cover the mattress with plastic. 3. Bedwetting alarms: There are generally reserved for older school-age children. There are commercial alarms that are available at most pharmacies. When the device senses urine, it alarms and wakes up the child so he/she can use the toilet. The cure rate is variable. 4. Bladder-stretching exercises are aimed at increasing the bladder volume and increasing the periods between daytime urinations. 5. Medications, such as DDAVP (desmopressin acetate or antidiuretic hormone) and Tofrinil (imipramine), have been shown to be very effective and are used to temporarily treat the nighttime urination, but they do not "cure" the enuresis. Many pediatricians will prescribe one of these medications, especially if the child is engaged in behavioral conditioning as well. Medications are very helpful when a child is not sleeping at home (camp or sleepovers), since the trauma of bedwetting in those settings is predictable. In addition, a recent study presented at the 2009 Pediatric Academic Society's annual meeting suggested that ibuprofen (Motrin, Advil, etc.) may also decrease the incidence of bedwetting by possibly stabilizing the bladder muscle that contracts during urination (detrusor muscle).

How common is secondary bedwetting?

Only approximately 2%-3% of all children with bedwetting have a medical cause for the condition.

What causes secondary bedwetting?

Urinary tract infections, metabolic disorders (such as diabetes), external pressure on the bladder (such as from a rectal stool mass), and spinal cord disorders are among the causes of secondary bedwetting.

How is the cause of secondary bedwetting diagnosed?

A complete history and thorough physical examination are central to the initial evaluation of a child with primary bedwetting. A urinalysis and urine culture generally complete the workup. Further laboratory and radiological studies are for the child with secondary bedwetting.

What is the treatment for secondary bedwetting?

Therapy of secondary bedwetting is directed at the primary problem causing the symptom of wetting the bed. As expected, cure rates vary depending on the cause of the loss of control.

What is the outlook (prognosis) for children with bedwetting?

In the medical world of today, both primary and secondary bedwetting can be a manageable condition. Treatment programs can successfully eliminate both parental and patient anxiety, frustration, and embarrassment.

source:medicinenet.com