What should I know about Bedwetting in children?
[mme_highlight] Despite being a common situation among children, enuresis is associated with embarrassment and a significant emotional impact for affected children and families. Most of bedwetting cases are not related with a medical condition and resolve by themselves. [mme_highlight]
The medical term for bedwetting is enuresis, which can be defined as wetting in small portions while asleep, in children older than 4 years of age. Despite being a common situation among children, enuresis is associated with embarrassment and a significant emotional impact for affected children and families.
Many people do not know that this is a treatable condition, in consequence some families prefer to keep enuresis a secret, waiting for a spontaneous resolution, rather than seeking for medical help.
How common is enuresis?
Enuresis is a very common problem among children, with surprisingly high prevalence in population, as shown in the table below.
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Prevalence of Enuresis
- By 6 years of age: 10% to 16%
- By 10 years of age: 5%
- Teenagers/young adults: 0.5-1 %
- A bladder that takes more time than usual to mature;
- A bladder that holds a quantity of urine below the normal.
- Genetics: children whose parents have had enuresis have highest odds to have enuresis too.
- Decreased quantity of vasopressin: leads to increase in urine production.
- Physical or emotional problems are rare causes of bedwetting.
- Medical conditions: Diabetes, urinary tract infections, kidney failure, seizures, sleep apnea, constipation.
- Source of distress both for child and family;
- Difficulty of “sleeping over” on holiday or at friends’ houses;
- Reduced self-esteem;
- Potential disturbance of the child’s and the parents’ sleep that may have an impact on daytime functioning;
- Untreated enuresis (especially if severe) can persist to adulthood, in 2 to 3% of cases.
- Do not punish your child for bedwetting, because it does not happen voluntarily, so it is not her/his fault.
- Put your child to pee frequently during the day and before bed.
- Avoid giving your child drinks with sugar or caffeine, especially at night.
- Try to give your child the majority of fluids during morning and afternoon.
- Put night lights in the alleyway to help your child find the way to bathroom easily during night.
- Ask your child to help you clean and set the bed.
- Do not allow siblings or other relatives to tease a child for bedwetting.
- Use a rewards system to motivate your young children.
- Enuresis is a common situation among children: approximately 16% of 5 year old children.
- Enuresis, the medical term for bedwetting, can have a negative impact in children’s and families’ lives.
- Most cases of enuresis resolve by themselves. If you are worried or if your child was formerly able to control sphincters and has loose this capacity you should seek a doctor.
- The most recommended treatments available are desmopressin and enuresis alarms.
- Vande Walle J, Rittig S, Bauer S et al. Practicalconsensus guidelines for the management of enuresis. Eur J Pediatr. 2012 Jun;171(6):971-83.
- De Jonge DA (1973) Epidemiology of enuresis: a survey of the literature. In: Kolvin I, MacKeith RC, Meadow R (eds) Bladder control and enuresis. Heinemann Medical Books, London
- Sit FKY, Yeung CK, Sihoe JDY, Liu JWH (2003) Self-esteem before and after treatment in Chinese children with nocturnal enuresis and urinary incontinence: a qualitative approach. ICCS Abstracts 40
- Tekgul S, Nijman R, Hoebeke P, Canning D, Bower W, von Gontard A (2009) Diagnosis and management of urinary incontinence in childhood. Report from the 4th International Consultation on Incontinence. Health Publication Ltd.
- Vande Walle J, Vande Walle C, Van SP et al (2007) Nocturnal polyuria is related to 24-hour diuresis and osmotic excretion in an enuresis population referred to a tertiary center. J Urol 178 (6):2630–
- Von Gontard A (2009) Psychological aspects of urinary incontinence, enuresis and faecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A (eds). Report from the 4th International Consultation on Incontinence. 4th edition. Health Publication Ltd, p. 760–
(Estimated for a wetting frequency of more than one “wet night” per month)
Prevalence – The total number of cases of a disease in a given population at a specific time.
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Is enuresis normal?
Yes, it can be, depending on each case. However, generally, enuresis is considered abnormal in children aged ≥5 years. Although most children older than 4 years are able to control their bladder while awake, they can take longer to control it during night.
What are the causes of enuresis?
Most of bedwetting cases are not related with a medical condition and resolve by themselves. Some possible causes for enuresis are listed below:
What can be the impact of enuresis for children?
Enuresis can have a negative impact on children’s lives in different ways, which can thus justify a proactive intervention:
How can I help my child?
What treatments are available?
There are some information you must have with you when you seek for a doctor, like a record of diary urine losses, the frequency of bedwetting episodes, family history of enuresis, if your child snores and impact of the problem for your child.
The first line treatment option is desmopressin, a hormone which reduces the volume of urine produced overnight to within normal range. It is particularly indicated for children with nocturnal polyuria (NP, meaning these children urinate many times per night), but whose maximum voided volume is not reduced compared to the normal for their age. This is further explained in the table below.
An enuresis alarm is recommended for children who have a reduced maximum voided volume but normal nighttime urine output. The alarm should be worn every night. The alarm is triggered when a sensor in sheets becomes wet – the alarm wakes the child, who stops voiding and arises to go to the bathroom.
Parents must help children to wake when the alarm is activated; otherwise, children can turn it off and continue sleeping. Note that response is not immediate and treatment should be continued for 2 to 3 months or until the child stays dry for 14 consecutive nights.
Combination therapy with desmopressin and an alarm can be considered in some cases.
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Expected age-related bladder capacity and voided volumes
| Age (years) | Expected Bladder Capacity (mL) | Maximum Voided Volume (mL) | Total Voided Volume (mL) |
|---|---|---|---|
| 5 | 180 | 117 | 234 |
| 6 | 210 | 137 | 273 |
| 7 | 240 | 156 | 312 |
| 8 | 240 | 176 | 351 |
| 9 | 300 | 195 | 390 |
| 10 | 330 | 195 | 429 |
| 11 | 360 | 234 | 468 |
| 12 | 390 | 254 | 468 |
A reduced maximum voided bladder suggests a reduced bladder capacity, a situation in which alarms can be beneficial. A total voided volume under the listed value suggests that the child urinates many times during night – nocturnal polyuria – so treatment with desmopressin should be considered.
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When should I be worried?
Each case is different. When a child who was formerly able to control sphincters during night is no longer capable of it, this is definitely an alarm sign. On the other hand, a 6-year-old child with enuresis whose father had enuresis too, may not bring great concern. In addition, if bedwetting is interfering in children’s social life, then it is a motif to worry too.
Summary
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References
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