Nocturnal Enuresis and Other Wetting Problems
- ENURESIS: Wetting. Usually used to describe wetting the bed at night.
- INCONTINENCE: Involuntary loss of urine
- NORMAL URINARY CONTROL: The ability to feel the need to urinate, to hold the urine until a toilet is reached, and to remain dry both day and night. (Daytime control usually precedes control at night.)
What causes enuresis?
Enuresis is probably caused by many factors, not just one. Most children with enuresis have a developmental delay in their ability to hold urine. Not all children develop this ability at the same rate, and gaining bladder control may take longer in some children. Other reasons to explain enuresis are chemical or hormonal factors, and in some children, emotional factors. Enuresis may also run in some families.
Children who have only night wetting and have never had urinary tract infections rarely have structural abnormalities of the urinary tract to account for wetting. Some children will have wetting problems during the day and night. This is usually very different from night wetting. Some children with this problem will have been perfectly dry for some period after toilet training. Some reasons to explain this are urinary tract infections, structural abnormalities of the urinary tract, or problems with bathroom habits. (This involves holding urine and bowel movements, infrequent or at times very frequent urination, incomplete bladder emptying, insufficient time spent on the commode to empty bladder or eliminate stool, constipation, hard stools, and painful bowel movements with straining. Many children with severe problems will be incontinent of stools.)
When should my child be evaluated for wetting?
Children beyond the age of 5 with wetting disorders should be evaluated. The initial evaluation should include a thorough history and physical examination, a urine analysis, and a urine culture to screen for infection. This can be done by your child’s pediatrician or family doctor, who may then wish to consult with the pediatric urologist. Further evaluation may be necessary to help determine the reason for your child’s problem. Frequently, the only tests that may be done are a sonogram and/or an X-ray of the abdomen and pelvis. The sonogram uses sound waves to screen for abnormalities in the urinary tract. It is safe, painless, involves no medications or needles, and is well tolerated by children. The plain X-ray of the abdomen allows the spine to be assessed and to see if there is a lot of stool apparent which suggests a constipation problem. If there has been a history of urinary infections or an abnormality is discovered on the sonogram, other X-ray tests may be recommended.
How common is enuresis?
Five to 10 percent of 5-year-olds and 1 to 2 percent of 10-year-olds wet the bed. It tends to be more common in boys.
Is there a cure for enuresis?
Yes. Fortunately, the majority of children with enuresis improve over time for reasons that are not well understood. It is important to convey to your child that this is a temporary condition in order to help them maintain a positive self-image. Patience and understanding are very important in the management of this problem. There are some treatments that are available to help get your child through this problem. One may work well for one child, but not at all for another. Nothing is 100% effective, and you should be wary of anyone who makes such claims.
Some other measures may have been suggested to you already:
- Complete bladder emptying before bedtime
- Limiting fluids to some extent after dinner
- Awakening your child when you go to sleep (2-3 hours after his/her bedtime)
- A positive reinforcement program to encourage participation by your child
For children in whom the above steps have been unsuccessful, other treatments may be useful. Some drugs may work well, but in some children, the wetting problem returns when the drug is discontinued. Other treatments for enuresis are alarm devices and for some children, acupuncture. Your pediatric urologist can help you to decide which treatment might be best for your child.
Children with wetting problems due to some specific factor (infections or a structural problem) will often show improvement once the cause is successfully addressed. Children who wet because of problems with their bathroom habits usually show improvement once they are “retrained” in going to the bathroom. This involves such things as voiding by the clock (timed voiding), complete bladder emptying, and a bowel program to promote a normal, daily bowel movement.
Your child’s wetting problem took time to develop and unfortunately, there is no quick solution. It may take awhile to solve the problem, and different steps may need to be taken to get things under control. Persistence and patience go a long way, but most children do get better when their problem is adequately addressed.
Bedwetting is evaluated and treated at our Continence Center/2-B-Dry Program.