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Nocturnal enuresis, also called Bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary (PNE) when a child has not yet had a prolonged period of being dry. Secondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry.

Most bedwetting is a developmental delay—not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.
Treatments range from behavioral-based options such as bedwetting alarms, to medication such as hormone replacement, and even surgery such as urethral enlargement. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve self-esteem. Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control.
Bedwetting is the most common childhood complaint. Most girls stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% and 2.3%.

What Is Bedwetting?

Bedwetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep . Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence .

For infants and young children, urination is involuntary. Wetting is normal for them. Most children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first, while nighttime control comes later.

The age at which bladder control is expected varies considerably.

  • Some parents expect dryness at a very early age, while others not until much later. Such a time line may reflect the culture and attitudes of the parents and caregivers.
  • Factors that affect the age at which wetting is considered a problem include the following:
    • The child’s gender: Bedwetting is more common in boys.
    • The child’s development and maturity
    • The child’s overall physical and emotional health. Chronic illness and/or emotional and physical abuse may predispose to bedwetting.

Bedwetting is a very common problem.

  • Parents must realize that enuresis is involuntary. The child who wets the bed needs parental support and reassurance.

Bedwetting is a treatable condition.

  • While children with this embarrassing problem and their parents once had few choices except waiting to “grow out of it,” there are now treatments that work for many children.
  • Several devices, treatments, and techniques have been developed to help these children stay dry at night.

What Causes  Bedwetting?

While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying illness. In fact, a true organic cause is identified in only a small percentage of children who wet the bed. However, this does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient.

There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).

In general, primary bedwetting probably indicates immaturity of the nervous system . A bedwetting child does not recognize the sensation of the full bladder during sleep  and thus does not awaken during sleep to urinate into the toilet.

The cause is likely due to one or a combination of the following:

  • The child cannot yet hold urine for the entire night.
  • The child does not waken when his or her bladder is full. Some children may have a smaller bladder volume than their peers.
  • The child produces a large amount of urine during the evening and night hours.
  • The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents are familiar with the “potty dance” characterized by leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.

Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting. Common causes of secondary bedwetting include the following:

  • Urinary tract infection : The resulting bladder irritation can cause lower abdominal pain  or irritation with urination (dysuria ), a stronger urge to urinate (urgency), and frequent urination  (frequency). Urinary tract infection  in children may in turn indicate another problem, such as an anatomical abnormality.
  • Diabetes : People with type I diabetes  have a high level of sugar (glucose) in their blood. The body increases urine output as a consequence of excessive blood glucose levels. Having to urinate frequently is a common symptom of diabetes .
  • Structural or anatomical abnormality: An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence  or other urinary problems that could show up as bedwetting.
  • Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.
  • Emotional problems: A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting. Children who are being physically or sexually abused sometimes begin bedwetting.
  • Sleep patterns: Obstructive sleep apnea  (characterized by excessively loud snoring  and/or choking  while asleep) can be associated with enuresis.
  • Pinworm infection : characterized by intense itching of the anal and/or genital area.
  • Excessive fluid intake.

Bedwetting tends to run in families. Many children who wet the bed have a parent who did, too. Most of these children stop bedwetting on their own at about the same age the parent did.

2 responses to “Bedwetting (Nocturnal enuresis)”

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