About Incontinence - Types of Incontinence - Enuresis
Medical Reviewer: Julian Wan, M.D.
While most children eventually grow out of bedwetting (usually by the age of five), five to seven million children in the U.S. continue to wet the bed after the age of six. Many of these children eventually stop wetting the bed in their late childhood or teen years, but some will continue to experience enuresis as an adult. Rarely, adults who did not previously experience enuresis will begin to experience bedwetting. This can be a warning sign of worrisome health issues like diabetes, urine infection or neurologic conditions. Nighttime bedwetting is called nocturnal enuresis, or just enuresis.
Why?
The cause of enuresis is unknown, although there seems to be a strong genetic link - often, one or both parents also experienced enuresis. There are also other proposed theories:
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The human body produces a hormone called vasopressin to hold onto water. Most people produce a surge of vasopressin at night which causes urine to become more concentrated (that's why urine is generally a darker yellow in the morning). Sometimes people with enuresis don't produce the surge of vasopressin, resulting in more urine than the bladder can keep in all night long.
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Many individuals with enuresis are described as "very deep sleepers", so they don't awake when the urge to urinate strikes. Some actually have sleep disorders such as sleep apnea or sleep walking. If these problems exist, correcting them will often improve or halt the enuresis.
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Some children will begin wetting the bed as the result of new psychological stresses in their life. This can be traumatic or benign events. A new school, new bedroom, or new sibling are common examples.
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Incontinence of any kind can be a symptom of an anatomic abnormality or other health concerns, so it's always important to seek treatment from an interested and knowledgeable health care professional.
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It is believed that some children may simply have smaller bladders that are unable to hold the usual amount of urine. Some children may grow out of bedwetting as they and their bladders grow. This was a popular theory several decades ago, but recent research suggests that this is not a major cause.
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It is not uncommon for children with conditions such as ADD, ADHD, depression, and autism to also experience enuresis, so there may be a link between these conditions and bedwetting.
Prevention
Because most enuresis is thought to be influenced by genetics, at least in part, prevention isn't possible. Efforts are often better placed in providing a supportive and understanding environment for children as they learn to control their bladder and bowel during both the day and the night. Keep in mind that most children stop wetting the bed by the age of five, but bedwetting after the age of five is not uncommon. When bedwetting does become a problem and medical help is sought, it's important for parents to honestly answer questions about their own medical history, including bedwetting - this will help the doctor determine if the enuresis is caused by genetics, or possibly some other condition.
Because psychological stress can play a role in some cases, it may be helpful to seek professional guidance during times of change in your child's life, including the birth of a sibling, death of a pet or family member, or a move to a new home or school. It's important not to punish a child for wetting the bed, and instead accept that it is a medical condition over which they have little, if any, control.
Treatment and Management Options
There is no treatment option for enuresis that has a 100% cure rate, which means you’ll probably have to experiment a bit with what works best for your situation. The sooner you see a doctor the sooner you can start figuring out what might be causing the enuresis and what you can do about it. The following are some options to discuss with your doctor:
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Some people find that helping their child get more sleep helps them to have drier nights. Try an earlier bedtime for a while and see if you notice a difference. (This may also work with adults who experience enuresis.)
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Try avoiding fluids for about two hours before bed. No one should ever go to bed thirsty, so drink some water if necessary. Also be sure to avoid foods containing a lot of liquid before bed, such as fruits, popsicles, etc.
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Avoid bladder irritants, especially before bed, such as citrus juices, chocolate, and especially caffeine.
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Adults may want to use absorbent products and children might try using pull-on type diapers. Using absorbent products for older children is controversial: some people claim that the use of "diapers" hurts the child's self-esteem by making him or her feel like a baby; other parents claim that the use of absorbent products gave their child a renewed sense of control over the condition. Use of diapers or pull-on style products has not been shown to delay gaining of control. If you use a product for your child, go shopping with him or her for pajamas that will conceal the product.
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Try waking the child up at regular intervals throughout the night to empty the bladder before it becomes full to the point of leakage. This is a common approach and is called “night waking.” It may not necessarily work: some children will be wet before he/she is awakened or the child may wet after being taken to the bathroom.
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Many people find great success with the use of alarms that awaken the individual as soon as they begin urinating during the night. Most alarm devices have a sensor end which is tucked into the diapers or underwear. The other end is attached to the pajama top or shirt. When wetting occurs, the alarm will both sound off and/or vibrate. Alarms have no side effects and the lowest relapse rate, but not every insurance plan will cover the cost.
Julian H. Wan, M.D. is Associate Professor, Department of Urology, University of Michigan Health Systems, with a specialty in pediatric urology. He describes his interest as follows: "My particular areas of interest in pediatric urology are in how basic practical issues and concerns can be addressed so as to best serve the needs of our patients and families. Great strides are being made today in understanding the fundamental genetic, biochemical, or molecular basis for many of the conditions which affect our patients, and it is hoped that someday in the future these developments will lead to a significant cure or treatment. In the meanwhile we must still have practical therapies which can be applied today." Dr. Wan received his M.D. fro the University of Michigan in 1985. He did his residency at the University of Michigan Medical Center, 1990, Ann Arbor, Michigan, United States and did his fellowship in Reconstructive and Pediatric Urology in1992 at the University of Michigan Medical Center. He recertified his Urology certification in 2004.
Page last modified 26 July 2009