Bed-wetting In Children - Enuresis

Bed-wetting in children

Urinary incontinence (enuresis) is the uncontrolled emptying of urine from the age of four to five years. By the age of five, 15 to 20 percent of all children suffer from occasional urinary incontinence, by the age of seven about ten percent and by the age of ten about three percent, two thirds of them only at night ("bed-wetting", enuresis nocturna). Boys are generally more affected than girls…

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• What are the causes of bedwetting?
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What are the causes of bedwetting?

The control of the emptying of the bladder is a complex process and is usually learned before the age of four. Delays and disturbances in bladder control are common, especially in connection with external disturbances. Even with children who are already continental, what is known as secondary enuresis can occur after exciting events or changes in the living environment. Bed-wetting should not be seen as a disease, but only as a habit, provided that functional and organic causes can be or have been excluded. Since enuresis nocturna occurs more frequently in some families, a hereditary component is also believed to be possible.

What are the symptoms?

A distinction is made between wetting during the day (enuresis diurna) and nocturnal wetting ("bed-wetting", enuresis nocturna), with combined forms also occurring. A further distinction is made between a primary enuresis - the child has never been permanently dry - and a secondary enuresis, in which the child wets itself again after having been continent for more than six months.

How is the diagnosis made?

The assessment includes family stress, the environment and living conditions, other illnesses and the child's psychomotor development. Possible stress factors are identified using psychological tests. Competitive situations with siblings, parental tension and individual reactions play a role here.

Nocturnal enuresis usually has no physical cause. In the case of daytime incontinence, a physical examination, urinalysis, ultrasound of the kidneys and urinary tract and the evaluation of a bladder diary (micturition log) are necessary for a diagnosis. For this purpose, the time and amount of urine are recorded day and night over a period of two to three days using a measuring cup and recorded in writing. If a serious illness is suspected or the findings are unclear, further examinations such as X-rays or a cystoscopy are carried out.

Note Nocturnal urinary incontinence does not require therapy in children under five years of age and in children who do not wet themselves more than once or twice a week. An essential prerequisite for a successful treatment is that the child himself has the desire to become dry.

How is bed-wetting treated?

The use of a doorbell mat (alarm therapy with electronic signal transmitter) is recommended for bed wetting. The sensor attached to the child's bed or sleeping clothes triggers a loud audible alarm when it gets wet. Every alarm is a "learning opportunity": The child wakes up and learns to stop the spontaneous emptying of the bladder. Since it is a learning process, dry nights are not to be expected initially, but after a few weeks.

Parents should keep a diary (bed wet? Alarm triggered?). If the alarm therapy is unsuccessful after six weeks, it should be interrupted and drug therapy with desmopressin started. If necessary, alarm therapy should be tried again after four to six months. If the bed-wetting occurs again later, the doorbell mat can be used again.

The prognosis for nocturnal enuresis is good. In many cases, the problem will go away on its own over time. Only 1 percent of children with nocturnal incontinence will suffer from it into adulthood. With daily incontinence, the chance of success depends on the underlying disease.

Whom can I ask?

Bed-wetting can be treated by a general practitioner in children over the age of five. In case of diurnal incontinence (enuresis diurna), a doctor for pediatrics or adolescent medicine or urology should be consulted. Psychological counseling or treatment or psychotherapy are also used if necessary. Parenting advice could also be helpful.