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Bedwetting (Nocturnal Enuresis)

By Dr Søren Rittig

By Keynote ContributorDr. Søren RittigPediatrics Professor, Aarhus University

Bedwetting, also known as nocturnal enuresis, is an uncontrollable leakage of urine from the bladder while asleep. 1

For children aged five years and older, bedwetting is abnormal and should not be considered a trivial condition. 2,3,4

Bedwetting is common; with approximately 5–10% of 7 year-olds regularly wetting their beds.5

Boy pee on the bed

Bedwetting can and should be treated6, but despite this, nearly half of parents do not seek help, as many believe that their child will eventually outgrow the problem.7

In fact, if left untreated bedwetting will not necessarily go away by itself and can persist for life, with approximately 1 in 100 people continuing to wet the bed into adulthood.8

Bedwetting can have a serious effect on the quality of life of children and their families9

Bedwetting can be very distressing for children, however, the impact is often underestimated and trivialized by parents and doctors.9

Children may suffer from feelings of low self-esteem at an age when image is extremely important for optimal personal development.10,11

Bedwetting is also associated with reduced day time functioning, including school and social performance.2,3,4,10,11

More than half of parents do not allow their children to spend time away from home, so they often miss out on social activities such as sleepovers at friends’ houses and school trips.12

A lack of understanding can also cause parents to be frustrated and this contributes to the child’s sense of failure and shame; reinforcing the social stigma surrounding bedwetting.13,14

Aside from the social and emotional stress, there is also a recognized economic burden on families.15 Bedwetting creates additional work for families in the form of increased household duties and so results in often substantial financial costs.16

Successfully treating bedwetting removes the burden placed on both the child and family.

The causes of bedwetting

A frequent misconception of bedwetting is that the cause is psychological; however extensive research suggests that this is not the case.2,3,4

Bedwetting is often caused by over-production of urine at night or reduced capacity of the bladder.

An inability to wake up to the signals from a full bladder is common for all bedwetting children.2,3,4

There are also likely to be genetic factors, with nearly two thirds of children who wet the bed having one or both parents with a history of the condition.17

Bladder filling and nervous control of bladder as it relates to enuresis

World Bedwetting Day raises awareness of the condition so that children and families can get the help they deserve

The International Children’s Continence Society (ICCS) and the European Society of Pediatric Urologists (ESPU) have launched World Bedwetting Day to raise awareness among the public and healthcare professionals that bedwetting is a common medical condition that can and should be treated.6

World Bedwetting Day 2015’s slogan is ‘Time to Take Action’, in recognition that much more can be done to diagnose and treat children who suffer from bedwetting.

The aim of World Bedwetting Day is to encourage children and their families to discuss the condition with their healthcare professional without embarrassment or guilt.

Children who wet the bed tend to feel a sense of shame,18,19 and it is hoped that increased public awareness will urge more families the get the help that they need.

World Bedwetting Day is initiated by a working group consisting of the ICCS and ESPU, and from 2016 onwards, will take place every year in May.

About Dr Søren RittigSøren Rittig BIG IMAGE[4]

Søren Rittig graduated from Aarhus University Medical School in 1987 and passed the ECFMG (Educational Committee for Foreign Medical Graduates, U.S.A.) exam in 1990.

He has completed a Research Fellowship at Aarhus University, Clinical Institute and Northwestern University Medical School, Dept. of Medicine, Chicago, USA.

He became a specialist in Pediatrics in 2002 and has been consultant in Pediatric Nephrology at Aarhus University Hospital, Aarhus Denmark since 2004.

In 2010 he defended his thesis on circadian regulation of urine output in normal children and children with nocturnal enuresis. He became full Professor in Pediatrics, Aarhus University in 2012.

He has since Medical School been heavily involved in research in childhood incontinence, especially nocturnal enuresis.

His research has been focusing especially on circadian rhythms and enuresis pathophysiology and treatment; e.g. the description of a deficient circadian rhythm of vasopressin secretion in nocturnal enuresis that was correctable with administration of the vasopressin analogue desmopressin.

Since 1992, he has also been involved in molecular genetic research of inherited forms of diabetes insipidus and other renal tubular disorders and his laboratory has contributed with description of many mutations in familial diabetes insipidus.

Søren Rittig has published app. 150 peer reviewed papers, 6 book chapters, and co-edited several supplements in International journals. Furthermore, he has supervised 20 PhD programs.

Since 1999, he has been director of Center for Child Incontinence in Aarhus and he is the current Scientific Chairman of the International Children’s Continence Society (ICCS). He also currently holds the post as Board member of the European Society for Pediatric Nephrology (ESPN).

Supported by Ferring Pharmaceuticals.

For more information please visit www.worldbedwettingday.com.

References

  1. Tryggve Nevéus et al. The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Report from the Standardization Committee of the International Children’s Continence SocietyJ Urol 2006;176:314-324
  2. Vande Walle J, Rittig S et al. Eur J Pediatr. Jun 2012; 171(6): 971–983
  3. Vande Walle J et al, Erratum to: Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2013;171:971-983
  4. Vande Walle J et al, Erratum to: Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2012;171:971-983
  5. Nevéus T. Nocturnal enuresis—theoretic background and practical guidelines. Pediatr Nephrol. 2011; 26:1207–1214
  6. Hjälmås K et al. Nocturnal Enuresis: An International Evidence Based Management Strategy. The Journal of Urology. 2004; 171:2545–2561
  7. Schlomer, Bruce et al Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care, Journal of Pediatric Urology (2013) 9, 1043e1048
  8. NHS Conditions: http://www.nhs.uk/conditions/Bedwetting/pages/introduction.aspx [Last accessed: October 2015]
  9. Nathan D, Nocturnal enuresis guidelines. Notthingham Children’s Hospital. 2014. 1-17
  10. Joinson C et al, Pediatrics. 2007 Aug;120(2):e308-16
  11. Theunis M et al. Self-Image and Performance in Children with Nocturnal Enuresis. European Urology. 2002; 41:660-667
  12. ERIC: http://www.eric.org.uk/Campaigns/BedwettingAwarenessWeek [Last accessed: October 2015]
  13. Morison M J. Living with a young person who wets the bed; the families’ experience. Br J Nursing 2000; 9 (9): 572-588
  14. Läckgren G et al. Nocturnal enuresis: a suggestion for a European treatment strategy. Acta Paediatr 1999; 88: 679-690
  15. Tryggve Nevéus et al, Enuresis – Background and Treatment Scand J Urol Nephrol Suppl 206: 1–44, 2000
  16. Schulpen TWJ. The burden of nocturnal enuresis. Acta Paediatr 86: 981-4. 1997
  17. Von Gontard A et al. The genetics of enuresis: a review. J Urol 2001; 166: 2438-2443
  18. Hagglof B, Andren O, Bergstrom E, Marklund L, Wendelius M. Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence Scand J Urol Nephrol Suppl. 1997;183:79-82
  19. Hjälmås K. Pathophysiology and impact of nocturnal enuresis. Acta Paediatr. 1997 Sep;86(9):919-2

Disclaimer: This article has not been subjected to peer review and is presented as the personal views of a qualified expert in the subject in accordance with the general terms and condition of use of the News-Medical.Net website.

Last Updated: Feb 3, 2016

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Comments
  1. Lisa Bolys Lisa Bolys Canada says:

    Do you have any experience with bedwetting alarms? I am considering getting one of these for my son. It seems like a better alternative to drugs, which have side effects and don't really address the problem of bedwetting.

  2. Helle Dahl Helle Dahl Denmark says:

    Og to a cranio sacral therapists to get treatment. From my experience it usually takes 5 sessions to get rid of the problem.

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