Enuresis (Bed-Wetting)
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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 & Evaluation
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:
improving daytime voiding habits through daytime timed voiding. Click here for TImed Voiding Sheet
Appropriate diet - avoiding bladder irritants such as avoiding caffeine and colas. Click here for a List of Bladder Irritants
Getting a balanced fluid intake throughout the day and avoiding evening fluid "loading" however they are allowed to drink if they are thirsty
Maintaining regular bowel function (avoiding constipation). Click here for the Dysfunctional Voiding Section - Go to Management of Constipation
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.
Medications
Medications are not used routinely to treat night-time wetting. Medications that have been used include:
anti-muscarinics such as Oxybutynin (Ditropan - 0.3mg/kg 2-3x/d) - this is most successful with children with daytime bladder over-activity
DDAVP (hormone that when taken at night decrease urine output) - dosage of DDAVP - 0.2- 0.6 mg for sub-lingual tablets, 60 micrograms (this is the starting dose - usually 1-3 melts used) -240 mg for melts, 20-40 micrograms for nasal spray
imipramine (25-50 mg/daily) - second line therapy due to side effects (cardiac arrythmias)
As medications have not shown a durable response, they are not used routinely.
Other therapies: Accupuncture and Hypnosis
There have been some tentative studies which have shown improvement with use of accupuncture and hypnosis but the mechanisms are not well-known.
On the Web
CUA patient information on enuresis
General Urology Websites
Canadian Urological Association Extensive library of downloadable pamphlets on a wide range of urological conditions
Medline Plus Produced by the US National Institutes of Health with information on virtually every health topic and extensive list of links
UrologyHealth.org The patient information site of the American Urological Association.