Nocturnal enuresis

Nocturnal enuresis

Description, Causes and risk Factors:

Nocturnal enuresis is a condition in which a person who has bladder control while awake urinates while asleep. The condition is commonly called bedwetting and it often has a psychological impact on children and their families. Children with the condition often have low self-esteem and their interpersonal relationships, quality of life, and school performance are affected.

Alternative Name: Bed-wetting.

ICD-9-CM: 788.36.

Urination or voiding is a complex activity. The bladder is a balloonlike organ that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord, and the brain.

The bladder is composed of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder can contract to keep urine back.

A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system matures. The child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.

Failures in this control mechanism result in incontinence.

Enuresis nocturnal is the defined as wetting the bed at night. More common in males than females, it is usually seen in the developmental stages of life. Nocturnal enuresis in children will most likely clear up as they develop, though there are documented cases of nocturnal enuresis in adults. Some studies have shown that up to 2% of adults suffer from enuresis nocturnal.

Bed wetting is seen in two forms, primary nocturnal enuresis, also referred to as primary monosymptomatic nocturnal enuresis, in which wetting the bed is seen early in life. If a child is not able to regularly stay dry the entire night by the age of 6 months, they may be suffering from primary nocturnal enuresis. The second form is Adult Onset Secondary Enuresis in which an adult starts to wet the bed without prior symptoms.

There many nocturnal enuresis causes both physical and emotional.

The physical aspects include:

    Small bladder.

  • Problems with the muscles involved in holding urine once the bladder is full.

  • Urinary tract infection.

  • Issues with sleeping.

Emotional issues could include:

    A change in lifestyle.

  • Relationship problems.

  • Problems with home life or depression.


Diagnosis of nocturnal enuresis is made when involuntary urination regularly occurs during sleep in a person who is continent while awake. Determining the cause for the condition requires a detailed medical history and a comprehensive physical examination.

Medical history includes the following:

    Assessment of psychological and emotional issues.

  • Fluid and dietary intake (especially late in the day).

  • Daytime voiding frequency and volume.

  • Sleep history (i.e., time the child goes to bed, falls asleep, and awakens; depth of sleep; timing of bedwetting; snoring; nightmares).

  • Periods of nighttime dryness and the circumstances.

Physical examination includes the following:

    Blood pressure.

  • Examination of the genitals.

  • Palpitation of the kidneys, bladder, and lower spine.

  • Neurological examination of the lower body including gait, muscle strength and tone, reflexes, and sensation.

Various diagnostic tests may also be performed to determine the cause of bedwetting. These tests are reserved for patients in whom physical abnormality or obstruction are suspected. Urinalysis is performed to detect cystitis, UTI, urethral obstruction, diabetes, and other possible physical causes.

Treatment Options:

Once you talk to your primary care provider, they may refer you to an urologist or someone that specializes in sleep disorders. Once they have reviewed the symptoms and possible causes there are a few ways to treat nocturnal enuresis.

One nocturnal enuresis treatment is behavioral therapy. The best place to start is to monitoring fluid intake before bed and making sure the bladder it is empty before sleeping. Training the bladder to hold more urine also a process that works for some. A bedwetting alarm (nocturnal enuresis alarm) can also be used to help alert the child when they are wet and train them to respond to the feeling of a full bladder.

Bed-wetting medications are another form of nocturnal enuresis treatment. These include Imipramine, Desmopressin or Anticholinergic Medications such as: Darifenacin, Tolterodine, Oxybutynin (Ditropan™), Trospium Chloride and Solifenacin.

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

With many cause and Bed Wetting Solutions, it is best to consult your doctor and discuss your concerns.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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