Nocturnal enuresis is the term used to describe when children urinate without control while they sleep. More commonly known as bedwetting. Incontinence is accidental or intentional urination in children who are at an age where they should be able to control their bladders.
Girls usually obtain bladder control before boys do. Doctors can diagnose incontinence in girls over five years old and boys over age six. Learn about bed wetting in children, different types, and treatments.
Causes of Pediatric Bedwetting (Nocturnal Enuresis) Urology Specialists Omaha
The exact cause is unknown, but many risk factors can make the ability to stay dry at night worse including:
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- Family History
- Slow Development of Brain-Bladder Control
- UTIs – Urinary Tract Infection
- Smaller than Expected Bladder Capacity
- Urine Production – Making Too Much Urine While Asleep
- Constipation: hardened feces make bowel movements difficult.
- Sleep Disorder (for example, obstructive sleep apnea)
- Stress
- Difficulty waking while sleeping
- Attention deficit hyperactivity disorder
Different Types of Pediatric Bedwetting (Nocturnal Enuresis)
- Diurnal Nocturnal Enuresis (daytime wetting)
- Nocturnal enuresis (wetting during the night)
- Primary Nocturnal Enuresis (occurs when the child has never fully mastered toilet training)
- Secondary Enuresis: occurs when the child has a period of dryness, but then returns to having periods of incontinence.
Secondary Enuresis: occurs when the child has a period of dryness, but then returns to having periods of incontinence.
How is Pediatric Bedwetting (Nocturnal Enuresis) Diagnosed
You’ll know if a child has enuresis if he/she is over the age of 6, and often wakes to a wet bed. You and your healthcare provider will want to learn the cause of the bedwetting.
Your child’s pediatrician will ask about how often this happens, and about other symptoms. Before your appointment, try to keep track of your child’s bathroom habits in a bladder diary. Include information such as:
- How often does your child urinate during the day and at night?
- How often does he/she pass stool and how hard or soft is the stool?
- Does your child drink fluids before bed?
If your urology specialist provider needs more information, your child may have the following tests done along with a physical exam:
- Urine culture & urinalysis: Urine tests check for infection, along with unwanted blood, and other elements in the urine.
- Blood test: Blood tests can check the kidney and thyroid. They can also check cholesterol levels and the presence of anemia, diabetes, and hormone problems.
- Bladder scan: This type of ultrasound shows how much urine is still in the bladder after urinating.
- Urodynamic testing: These tests check to see how well the lower urinary tract stores and releases urine.
- Cystoscopy: During this test, a narrow tube with a lens is inserted into the bladder. Checking for tumors or other more serious medical conditions.
Pediatric Bedwetting Treatment Options
Many treatment options are available for bedwetting, some work better than others. Often, treating bedwetting starts with simple changes like:
- Reducing the amount of fluids your child drinks 1-2 hours before bed avoiding a full bladder.
- Creating a schedule for bathroom use (changing toilet habits)
- Bedwetting alarm devices
- Prescription Drugs
You can use these strategies one at a time, or together.
The following strategies have not been shown to help:
- Stopping food and fluid intake
- Night waking
- Pelvic muscle exercises
- Alternative therapies
Drugs
Desmopressin acetate (DDAVP)
Desmopressin is made from the hormone “vasopressin”.
In normal conditions, vasopressin is produced by the kidneys when the body tries to conserve water. For example, athletes secrete more vasopressin when they are active and sweating. Most people have naturally higher levels of vasopressin during sleep. That is part of the reason we can sleep through the night without needing to pass urine.
In many children with enuresis, this hormone surge is absent. DDAVP is available as a pill. You can take it an hour before going to bed for 3-6 months, with a one-week break. Decreasing the volume of urine made, and used with a schedule of drinking less fluid.
Oxybutynin and Tolterodine
These prescription drugs stop the bladder from having spasms with overactive bladder symptoms. When a child has a small bladder capacity, It is helpful to increase that capacity.
Imipramine
Doctors have used Imipramine, which is an anti-depressant medication to treat children with bedwetting for many years. It does not mean that depression is a cause for bedwetting.
It is not clear how imipramine helps, however, it is believed to improve the child’s sleep patterns and bladder capacity. Side effects can include irritability, insomnia, drowsiness, reduced appetite, and personality changes.
Usage and storage of this drug safely is crucial because overdose can be deadly.
Finally, your healthcare provider should look for signs of constipation. Doctors recommend treatment with dietary advice and laxatives. This may help with your child’s bedwetting issue long term.
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