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Bedwetting

Enuresis nocturne (Latin name)

By Bjarne Lühr Hansen PhD, MD and Philipp Skafte-Holm MD, Mentor Institute

Bedwetting appears with every fifth child who is more than 6 years old and disappears before far most enter their teens. The condition is hereditary. Why some children suffer from bedwetting is unknown but psychological causes are very rare. There are currently two effective treatments, medication and bedwetting alarm – the latter being the most effective.

When a child involuntarily wets itself at night it is called bedwetting, involuntary nocturnal urination or Enuresis nocturne (Latin)

Most children learn in time to keep dry at night. However, every child in 5 will still wet its bed at the age of 6. When the children reach their teens only very few (2-3%) still cannot stay dry during night. Around 1% of all adults live their life to the end still wetting their bed.

It is very rare to find a good explanation for why the child suffers from bedwetting. It is hereditary for sure, which means that if the child’s siblings or parents have suffered from involuntary nocturnal urination there is a heightened risk that the child will have the same problem.

Involuntary nocturnal urination is caused by a discrepancy between the amount of urine produced during the night and the amount of urine the child’s bladder can contain. If more urine is produced during the night than what the bladder can contain, it results in the child needing to urinate. Most children wake up and go to the bathroom but children who suffer from bedwetting do not wake up and therefore wet their bed.

The amount of urine produced at night depends on how much the child has drunk before bedtime and on a certain hormone (the antidiuretic hormone). The hormone makes sure the child does not produce too much urine during night.

With some children it is possible to find a different explanation for bedwetting. Typically, this involves a child who used to be able to stay dry at night and suddenly starts to wet its bed. The explanation can be psychological or medical. Psychological explanations can be problems at school, divorce or death in the family. Medical explanations can be cystitis or diabetes. However, with far most children there is no explanation. Former presumptions that bedwetting is caused by psychological problems are rarely true. The child does not wet its bed in protest or to have its way.

Causes for bedwetting:

  • The child produces too little antidiuretic hormonethe
  • Child’s bladder is not yet fully developed
  • Rarely psychological or medical conditions

Even though involuntary nocturnal urination is not dangerous and most children grow out of it, it has great significance for the child and therefore must be taken seriously. The child does not want to sleep over at friends and perhaps tries to avoid camps or trips involving spending the night because it is embarrassing to wet your bed. It may result in teasing and lack of self-esteem.

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Medication

Many children who wet their beds do not produce enough antidiuretic hormone during night. You can therefore attempt giving the child extra antidiuretic hormone. The medicine is effective but a lot of children have involuntary nocturnal urination again, once they stop taking the medicine.

What can you do?

It is important to explain to the child that involuntary nocturnal urination is not a serious condition and that it almost always disappears again. If other family members have had the same problem, it is advisable to tell the child how this person and this person outgrew it. It helps the child to know that it’s not the only one who has this problem. The child alone should decide whether it should wear a diaper to bed. Some children prefer sleeping with a diaper rather than waking up in a wet bed, while others prefer a washable sheet.

Parents can try to hold back on fluids before bedtime and wake the child a couple of times during the night and help it go to the toilet. If this does not help, there is reasons to seek help with a doctor

Contact the doctor tomorrow

If the child is more than 6 years old and bedwetting is a problem for the child and/or the parents. If the child usually keeps dry at night and suddenly starts wetting the bed again.

A doctor will first of all make sure that the child does not suffer from diabetes or cystitis. If this is not the case the doctor together with the parents will choose a treatment. Through time many different treatments have been attempted, but only treatment with medicine (the antidiuretic hormone) and bedwetting alarm have proven effective. Bedwetting alarm is an attractive form of treatment since the child does not have to take any medication. The alarm is a ringing-apparatus that is activated when the sheet becomes wet. The purpose of the alarm is to change the child’s feeling/sense of a filled bladder from: an urge to pass water to: a signal to squeeze and withhold the urination and wake up. The bedwetting alarm is effective and only a few children wet their beds again when the alarm is removed. Antidiuretic hormone is just as effective as the bedwetting alarm but a lot of children wet their bed again when they stop taking the medicine. In conclusion, the bedwetting alarm is most effective. Usually, it takes several weeks before the treatment becomes effective.

Contact the doctor immediately

Contact the doctor immediately

This is never necessary.