Nocturnal Enuresis (bed-wetting)

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Nocturnal enuresis (bed-wetting)

What is bed-wetting (nocturnal enuresis)?

Bed-wetting is most common in children. Nocturnal enuresis is the technical term for bed-wetting at night which is accidental, repeated and occurs when a child is asleep and has reached an age at which this should not happen.

What are the causes and risk factors of nocturnal enuresis?

During the first two to three years of life bed-wetting at night is normal and expected. Thirty per cent of children at the age of four years still wet the bed. Ten per cent of children at the age of five to six years wet the bed and a little less than five per cent still do so at the age of 10 years. One per cent still wet the bed by the age of 18. Nocturnal enuresis occurs more commonly in boys than in girls.

Of those children with night-time bed-wetting, only a tiny proportion, between one and two per cent, have a physical disorder. Such disorders include:

urinary tract infections (the urinary tract consists of the kidneys, bladder and the tubes connecting them and leaving them, along which urine flows),

anatomical ...
... abnormalities of the urinary tract, such as narrowing of the urethra (the channel from the bladder through the penis, along which urine flows),

abnormal nerve control of the bladder (neurogenic bladder),

untreated diabetes (which causes excessive production of urine).

Nocturnal enuresis can also have psychological causes. It is more common in children from families in which emotional difficulties are found. A psychologically stressful event can often cause bed- wetting to start again after it has stopped.

What are the common symptoms and complications of nocturnal enuresis?

The only real complication of bed-wetting is the often deep embarrassment and humiliation felt by sufferers. Parents play a vital role in helping a child cope with this problem.

How do doctors recognise nocturnal enuresis?

Continued bed- wetting after the age of three years does not necessarily indicate a problem, and the doctor will usually suggest that you simply ‘wait and see'. This is sound advice, as bed- wetting usually stops on its own.

If a child is still bed-wetting at the age of six years, however, the doctor first tries to rule out any physical causes of the bed-wetting. Tests on the blood and urine are carried out to look for infection or diabetes.

What is the treatment for nocturnal enuresis?

If no physical cause is found and the child is less than six years old, your doctor usually suggests that you simply monitor the situation, and he or she will not recommend any specific treatment.

Whatever the child's age, however, a useful strategy is for the child to empty the bladder and avoid drinking fluids for a couple of hours before going to bed.

Medicines

Medicines are rarely prescribed because bed-wetting alarms are so effective. Two types of drugs can be given. One is a type of antidepressant called imipramine. It has the effect of relaxing the bladder and tightening the sphincter (preventing the passing of urine). Although it works quickly, most children start bed- wetting again when the drug is stopped. It can also have potentially serious side effects.

Another drug is called desmopressin. It is taken as a nasal spray and reduces the output of urine. Again, relapse of bed-wetting is common.

What is the outcome of nocturnal enuresis?

For the vast majority of children, night-time bed-wetting requires no treatment and goes away on its own, with time. It is extremely common and usually does not mean that there are any physical or psychological problems. Understanding and support for the child from parents is an essential part of treating this condition and helps to reassure the child that he or she should not feel guilty or anxious about their bed- wetting.

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