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Saturday, May 25, 2013
Bedwetting, also known as sleep-related enuresis, is the involuntary release of urine while a child sleeps. Sleep-related enuresis is common in children with an incidence of about 30% of four year olds, 15% of five year olds, and 10% of six year olds. It gets better by itself as children get older with only 3% of 12 year olds and 1% of 15 year olds remaining affected. There is a clear genetic predisposition with the highest incidence (75%) occurring in children whose parents were both enuretic (bedwetters) during childhood.
The exact mechanism that explains the cause of sleep-related enuresis has not yet been discovered. It is considered a disorder of arousal in which the enuretic child fails to awaken during episodes of bedwetting.
There are two forms of enuresis: primary and secondary.
Primary enuresis. Sleep-related enuresis is termed primary when the child has not had a period of more than 3 months of sleep continence (or being dry at night) since birth. This is the most common form.
Secondary enuresis. Secondary enuresis is nighttime urination that redevelops in a child who was previously dry during sleep for at least 3 months. The secondary form is less common and is a cause for more concern.
Enuresis can be treated after a careful evaluation to determine if there is a potential cause of the problem (such as upper airway obstruction) that may need specific therapy. If not, then interventions geared towards the bedwetting can be tried. A careful history should be taken for other nighttime symptoms that could signal another sleep disorder that is contributing to the bedwetting, such as snoring, frequent leg movements or unusual movements at night. Prior urinary tract infections and difficulty with urination, including daytime urgency or frequency of urination, are also important in the history.
Non-medication interventions may include beeper systems worn at night. These alarms awaken the child to urinate and can result in remission rates of 50 to 70%.
Medications can also be used, with some older children being treated with a bedtime oral dose of Desmopressin (DDAVP). DDAVP is a synthetic analog of a hormone that controls body water excretion. This therapy helps in 60-75% of children. Response with DDAVP is rapid, often within a week.
It is recommended that parents discuss their child's bedwetting problem with the child's pediatrician or family practitioner. They will gather additional information and determine if any testing is needed or if a trial of treatment can be performed.
The good news is that children are likely to outgrow bedwetting as they get older. Until this happens, we generally suggest that they wear commercially available extra-absorbent underpants such as pull ups during the night to reduce laundry concerns.
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Last Reviewed: Apr 05, 2011
Mark Splaingard, MD
Clinical Professor of Pediatrics
College of Medicine
The Ohio State University