Information for parents of children with nocturnal enuresis
1. Is it a common problem?
Enuresis, or bedwetting, is very common in childhood. It affects approximately 5-10% of children under 10 and can sometimes continue into adolescence. It is equally common across cultures and social backgrounds. It is slightly more common in boys than girls, and much more common if either parent experienced bedwetting as a child.
2. What causes bedwetting?
Bedwetting was once thought to be a psychiatric problem, but this is completely false. When a child wets the bed, neither the child nor the parents are to blame. Modern studies have identified three main causes:
- Almost all children with enuresis have difficulty waking from sleep at night: they have a very high waking threshold.
- Some children with enuresis have kidneys that produce too much urine at night, a condition called nocturnal polyuria.
- Some children with enuresis have an overactive bladder, which contracts more often, involuntarily and too early.
As mentioned above, bedwetting is also more common in children whose parents experienced enuresis during childhood, so there is a genetic component too.
3. Is bedwetting dangerous or harmful?
Bedwetting does not cause damage to a child’s body. Sleeping in wet sheets, for example, does not lead to more urinary tract infections. However, some children with enuresis experience low self-esteem or difficulties with social relationships.
4. How is bedwetting treated?
General measures
Many people try to solve the problem by banning drinks in the evening or at night, or waking children to pass urine during the night. However, these strategies are rarely effective.
It is much more effective to improve the child’s bladder and dietary habits. Make sure the child passes urine 6 times a day at regular intervals: on waking, mid-morning, at lunchtime, in the afternoon, at dinner time and before bed. Rather than banning drinks at night, it is more effective to increase fluid intake in the morning and at lunchtime.
Children who also have daytime urinary incontinence should be assessed and treated for that problem before treatment for bedwetting begins.
Parents should explain that bedwetting is not the child’s fault. It is very important not to restrict the child’s social activities because of enuresis.
Active treatment
There are three basic approaches, depending on the cause: a bedwetting alarm, desmopressin (Minurin®) and anticholinergics, such as oxybutynin, Ditropan®. This post provides only a brief overview of these treatments.
A bedwetting alarm makes a sound when the child wets the bed, gradually teaching them to recognise the signals their body sends when the bladder is full. It is probably the most effective treatment.
Desmopressin reduces the amount of urine the kidneys produce at night. It is useful for children who produce a large amount of urine during the night.
Anticholinergics increase bladder capacity and reduce involuntary bladder contractions. They are useful for children with an associated overactive bladder, but a full urological assessment is needed before starting treatment.
The important point is that treatments are available for the main causes of bedwetting, and each child can benefit from a personalised treatment or a combination of approaches. Almost all children with enuresis can stop wetting the bed with the right treatment!
The aim is for no child of school age to wet the bed. In future posts, we will look more closely at each treatment. Do not miss them!