What is nocturnal enuresis?

Bedwetting (nocturnal enuresis) is the act of urinating during sleep, particularly at the age of 5 or older. When children wet only in their sleep, that is called monosymptomatic nocturnal enuresis (MNE).

There are two types of MNE:

• Primary nocturnal enuresis (PNE) refers to children who have never had a period of dryness lasting 6 months or more.
• Secondary nocturnal enuresis refers to children who start wetting the bed again after staying dry for 6 months or more.

PNE is common in children and affects a small to moderate percentage of each age group:

• 5 to 6 years: 15-20%
• 8 to 10 years: 6-10%
• 11 to 13 years: 4-5%
• 14 to 16 years: 2-3%
• 17-18 years: 1-2%

Causes

There are several factors that can lead to bedwetting:

• Genetics: Bedwetting can be hereditary. If there is a family history of bedwetting in parents, siblings or close relatives, your child is more likely to inherit the condition.
• Sleep pattern: Most children who wet at night are heavy sleepers and don't wake easily, even when their bladder is full. Children with obstructive sleep apnea may also be at increased risk of bedwetting.
• Hormone production: The body releases a hormone called vasopressin that reduces urine production during sleep, usually starting in early childhood. If your child is not yet producing this hormone, their body may produce more urine at night than their bladder can hold.
• Bladder function and size: As your child grows, so does their bladder and its ability to hold urine during sleep. Once your child’s bladder is big enough to match the amount of urine they produce, accidents should stop.

Treatment

Each year, we treat more than 700 children for nocturnal enuresis. With the experience and expertise of our DOVE team, we can decide what approach may help your child and work best for your family.

Your child’s visit with us will include a thorough history. We want to understand your child’s daytime voiding and stooling/bowel habits as these may contribute to bedwetting. Many children who do not void regularly during the day will wet at night. Working to change daytime voiding and stooling habits may reduce the degree of night wetting.

Recommendations to optimize daytime voiding include:

• Increasing the amount of water consumed during the day. Many children tend to drink most of their fluids between the time they get home from school and bedtime. We encourage children to drink most of their fluids earlier in the day.
• Limiting fluids for 2 hours before bedtime.
• Urinating on a routine schedule of every 2 to 3 hours during the day.
• Double voiding before bed. If bedtime is at 8 p.m., have your child empty their bladder at 7 p.m. and then again at 8 p.m.
• Monitoring for any signs of constipation and treating it if needed.
• Cutting back on drinks that contain ingredients that irritate the bladder: caffeine, carbonation (fizz/bubbles), citrus juices and sports drinks.

If your child does not see improvement from changing their daytime habits, they still have two main options for managing their bedwetting.

The bedwetting alarm

The bedwetting alarm is a form of conditioning therapy to help your child begin to recognize the need to wake up to go to the bathroom. Bedwetting alarms consist of a sensor to detect wetness and an alarm to awaken the child. The alarm rings when your child starts to release urine.

In the beginning, your child will need your help to wake up to the alarm (they might sleep through it otherwise). This method requires commitment from both you and your child. It works for 60 to 70% of families who use it consistently.

You can expect to see progress in the first few weeks, although it may take 3 to 4 months to achieve mostly dry nights. As your child’s condition improves, they will void less at night and start to wake up when their bladder is full — without help from you or their alarm!

Medication

Desmopressin (DDAVP®) concentrates urine so that your child makes less urine at night and does not completely fill the bladder. DDAVP® is effective in about 50% of patients.

There are other medications that can help your child’s bladder hold more urine at night and reduce bedwetting. Your provider will discuss these with you if they seem appropriate for your child.

We understand how stressful night wetting can be for you and your child. We will work with you to find the best treatment plan for your family. We will continue to follow your child in our DOVE program to maximize dry nights.