Bedwetting Enuresis

Bedwetting (enuresis) is very common. It is often ignored and passed off as something to "grow out of". It can cause a significant degree of stress to child and the family. About 80% of children have never had control for more than 12 months of their early childhood (primary nocturnal enuresis). The rest being known as secondary nocturnal enuresis.

Within the 5 to 10 year old age group in Australia, 100,000 to 150,000 children regularly wet the bed at night.

In primary school there will be several bed wetters in each class, and in secondary school at least one in each class.

It is more common in boys in earlier childhood than girls, but this evens out in later childhood.
This has no consequence in the management of bedwetting, or the good results.

Most Children will grow out of it, however the question in when. About 15 - 20% cease wetting each year.
Some go on into adult life (½ -1%).

Family History / Genetics	A family history is quite common. It's presence does not effect the rate of cure. Possibilities for an enuresis gene involved in primary nocturnal enuresis appears to in chromosome areas: 13q, 12q, 8q, 20q, and 10q. Risk to your Child If 1 parent used to wet the bed - 35 - 40% Both parents used to wet the bed - 75 - 80%
Bladder Capacity - "Small bladder"	There is no evidence that a small or unstable bladder contributes to night time wetting. Wetting, however, is more likely to occur when the "functional bladder capacity" (i.e. the urge to go) maybe low.
Urine Concentration	Normally urine is concentrated at night with release of the hormone A.D.H. (anti-diuretic hormone). ADH "instructs" the kidneys to concentrate the urine, lowering the amount of urine produced. In many (not all - 2/3rds ), ADH production is not increased at night and children often then flood the bed. This does not explain why they do not wake up.
Sleep and Arousal	A complex issue. It is known that wetting occurs during all stages of sleep. Not all children are deeper sleepers, but wetting may relate more to moving between stages of sleep. Sleep Apnoea (stopping breathing) is associated with night time wetting. This is usually manifest by snoring, stopping breathing and restarting with a gasp. Large adenoids may be to blame.
Social and Emotional	Whilst in some children that wet, there may sometimes be associated emotional or behavioural problems, the association is not clear.
Maturity	Delayed maturity would account for the spontaneous cure rate, however as most children respond very rapidly to an alarm, this is less likely as a cause.
Toilet Training	Variable opinions exist. Attempts to train before 18 months may inhibit the normal processes of getting dry. There is also postulated a sensitive period for bladder training around the 3rd year of life. Stresses around this time may interfere with the chances of the dryness.
Constipation	Often associated with wetting. Possibly by giving confusing signals to the brain, or by "irritating the bladder".
Medical Problems	Uncommon - Must Exclude Structural problems / Infections
Diet	Caffeine can irritate the bladder
Fluids	Reducing fluids is of NO Help Increased fluids during the day is helpful
ADHD	Produces a higher frequency of Night Wetting

The relationship of arousal to a full bladder - increased night urine production and reduced bladder capacity (functional) seems to be at the basis of night wetting. That is children need to wee at night but do not wake up to do it!

Problems Associated with Bedwetting