Bed Wetting (Enuresis)

 

Background

 Bedwetting, or enuresis, is a common household concern. Studies suggest that 15% of children still experienced bedwetting at the age of 5 years and 1% of all 15 year old children continue to wet the bed. As a result, it is more common than children and parents think. At least 0.5% of adults experienced ongoing enuresis which need to be managed into adulthood. 

 

Causes

 The far majority of enuresis cases or idiopathic (cause unknown). Often parents also experienced nightime wetting. If one or two parents had bed-wetting there is a 40-80% chance that their children will also experience bed-wetting, however the genetic link is unknown. These are simply healthy children who will eventually outgrow the problem. Foreskin irritations in uncircumcised boys can sometimes present as enuresis. For a few, it can be a presenting sign some underlying condition such as neurogenic bladder or diabetes. Rarely there is a structural anomaly.

 

Diagnosis & Evaulation

 A history and physical examination along with ancillary tests as felt necessary. Sometimes these tests will include a blood test [e.g. to rule out diabetes] and urine test. Routinely a renal and bladder ultrasound can help to rule out a structural abnormality. Over 95% of the time these tests are normal.

 

Treatment

The majority of children are treated with conservative measures. The natural history of bed-wetting is the 4% of children per year will "grow out" of their incontinence or it resolves on its own. 

Nighttime dryness can be improved with the use of night-time bed wetting alarms. Studies have shown a 60% improvement in night-time dryness with the use of different alarm systems. This routinely takes 6-12 months to take effect. Alarm systems are most effective when the patient and their family are motivated to be dry at night. Alarms can be as simple as setting a bed-side alarm clock or watch to void throughout the night or using an bed-wetting alarm system that are available commercially. 

The majority of cases where the problem is idiopathic and self-limiting. Treatment is usually to help minimize the problem until it resolves on its own. Some strategies which can be used include:

 

 

 

  • Getting a balanced fluid intake throughout the day and avoiding evening fluid "loading" however they are allowed to drink if they are thirsty. 

 

 

  • Voiding just before bedtime.

 

  • The "parental" bed wetting alarm - Waking the child up in the middle of the night to void before wetting occurs e.g. midnight.

 

  • Considering the use of a bed alarm which can be obtained on line or at a full service pharmacy. See the link below for on-line alarm systems.

 

 

 

 

 

 

On the Web

CUA patient information on enuresis

Bed-Wetting Alarm Systems

 

Author: Dr J Mickelson - last edit May 2013