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What is enuresis?

Enuresis is the medical term for bed-wetting while sleeping. Bed-wetting is fairly common among children. It is often just a stage in their development. Bed-wetting is more common among boys than girls.

SYMPTOMS

The primary symptom of enuresis is wetting the bed at night while sleeping when you are age 5 or older. This could happen a few times a week or every night. Many kids who wet the bed are very deep sleepers. For most, urinating while sleeping is the only symptom.

What causes bed-wetting?

Bedwetting is not a mental or behavior problem. It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom. A number of things can cause bed-wetting. Some of the more common causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Stress
• Slower than normal development of the central nervous system (which reduces the child’s ability to stop the bladder from emptying at night)
• Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• A small bladder

When do most children achieve bladder control?

Children achieve bladder control at different ages. If a child is younger than 5 years of age, treatment for bedwetting is not necessary. Some children don’t stay dry at night regularly before age 7. Bedwetting up to that time is not unusual, even though it may be frustrating to parents.

DIAGNOSIS

How is enuresis diagnosed? Most children who wet the bed are healthy. Your healthcare provider can help you determine whether your child’s bedwetting is caused by a medical problem. First, your healthcare provider will ask questions about your child’s daytime and nighttime bathroom habits. Then your healthcare provider will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes.

Your healthcare provider may also ask about how things are going at home and at school for your child. Although you may be worried about your child’s bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your healthcare provider will also ask about your family life, because treatment may depend on changes at home.

PREVENTION

Can enuresis be prevented or avoided?

Enuresis cannot be prevented or avoided. It tends to run in families. It is not something the child can control, so they can’t avoid it.

TREATMENT

Most children outgrow bed-wetting without treatment. However, you and your healthcare provider may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine.

Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments you can try at home include:

• Limit fluids before bedtime.
• Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
• Use an alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
• Create a reward system for dry nights. But do not punish your child when they have an accident.
• Ask your child to change the bed sheets when they have an accident.
• Bladder training: have your child practice holding their urine for longer and longer times during the day, in effort to stretch the bladder so it can hold more urine.

What kinds of medicines are used to treat bed-wetting?

Your healthcare provider may give your child medicine.  This usually only happens if your child is 7 years of age or older and if behavior therapy has not worked. Medicines aren’t a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

Living with enuresis

Bed-wetting can lead to behavior problems because a child may feel guilt and embarrassment. It’s true that your child should take responsibility for bed-wetting. They could do this by helping with the laundry. But your child shouldn’t be made to feel guilty. It’s important for your child to know that bed-wetting isn’t their “fault.” Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Remind your child that it’s okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child’s mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

Almost all kids who wet the bed stop eventually.

FOR MORE INFORMATION

Canadian Paediatric Society’s Caring For Kids Website at
http://www.caringforkids.cps.ca/handouts/bedwetting