Bedwetting, known technically as Primary Nocturnal Enuresis, or just plain Enuresis1, has been around for thousands of years. Indeed, the term ‘Enuresis’ is the Latin medical name for a Greek word meaning to urinate in. So, the ancient Greeks were obviously acquainted with the matter of involuntary night-time wetting.
The first references to bedwetting are found in the Ebers papyri, Egyptian medical manuscripts on herbs and cures, written around 1550 BC, over 3,500 years ago! The cure recommended for bedwetting was to boil faïence beads, made of steatite or soapstone, and make a pellet for the child to ingest...it was apparently the magnesium released on boiling the beads that provided its medicinal value!
Fast-forward several millennia and there has been good, evidenced-based, research identifying some of the underlying causes of enuresis and appropriate treatments regimes. However, even though it is one of the most common paediatric health issues affecting 15-20% of five-year-olds, 6-8% of eight-year-olds and 1-2% of over fifteen-year-olds, our reticence to talk openly about bedwetting means that affected families and many health practitioners often have a limited understanding of its causes and cures.
Part of the reason may be the embarrassment - uncontrolled urination does not invoke the same feelings of sympathy for the sufferer as do more pernicious diseases and conditions. Also, because enuresis is a pathologically benign condition-no-one dies from it- and there is a spontaneous cure rate in 15% of bedwetters per year, it is often the expectation that time will be the antidote.
This approach may work where the child is in a caring and supportive environment, but peer pressure can often lead to self-esteem issues and, in this case, the best approach is to treat it.
Enuresis tends to favour boys until adolescence -around 2/3 of bedwetters are boys and 1/3 are girls. By adolescence, the ratio is closer to 50/50. During late teens, however, around two-thirds of bedwetters are female, while one-third are male. There is no scientific explanation for bedwetting’s gender bias at certain age groups. A possible explanation is that girls mature faster than boys then boys close this gap as they get older.
Genes are an important factor in bedwetting. If one parent was bedwetter then a child has a 40% chance of being one too, and, if both parents were this increases to 70%. Some clinics report that if bedwetting also occurred in grandparents, immediate uncles and nephews, then the child has a more than 90% chance of being a bedwetter.
Unfortunately, despite genes, if a bedwetter’s parent/s outgrew bedwetting at a certain age this doesn’t mean that the child will too.
Involuntary night-time urination in children can take several forms:
The child is dry during the day and only wets during the night. Up to 75% of bedwetters are mono-symptomatic.
The main causes of mon-symptomatic enuresis are usually developmental:
Also, some children also have small bladder capacity in conjunction with these symptoms.
The child is dry during the day but displays symptoms of Lower Urinary Tract dysfunction (LUTD). Up to 25% of bedwetter are non-mono-symptomatic.
LUTD can include:
Alarm treatment can be very successful for children with high arousal thresholds.
In the case of nocturia, pharmacological treatments such as desmopressin2 can also produce improvements where low levels of ADH are indicated and the child is unresponsive to alarm treatment or Urotherapy. However, it is generally not prescribed for children under 6 years old because of the risk of rare but harmful side effects.
Diagnosis of the cause of LUTD in children with non-mono-symptomatic enuresis requires proper Uroflowmetry3 and Scan analysis4.
Urotherapy including programmed toilet visits can help children with an overactive bladder. Where small bladder capacity is implicated together with an overactive bladder then anticholinergics5 may provide an improvement in the child’s bedwetting when Urotherapy fails.
However, not all children with an overactive bladder and small capacity improve with anticholinergics and bladder training. In this case bladder biofeedback6 can be successful.
Treatment of atypical toileting where there is dysfunctional and incomplete voiding may require biofeedback or urologist referrals.
Treating and curing enuresis can be beneficial to a child’s self-esteem, particularly if it is undertaken before their social and school calendar involves nights away from home e.g. sleepovers and school camps.
Treating bedwetting can also be an early lesson in resilience, persistence and the ability to problem-solve, all good skills for later in life.
There are also benefits for the household budget in terms of reduced laundry costs and diapers….and, hopefully, more sleep!
If you would like to discuss this please contact me or leave a comment below.