Sleep enuresis goes under several names. One alternative name is nocturnal enuresis since enuresis is split into day and night categories. For most parents, however, the familiar term is bedwetting. Bedwetting is common among most children up until the age of 7, after which almost all cases of bedwetting stop entirely. It’s basically expected of a child to wet their bed, to the point where it’s not even classified as a problem until age 8 or older.
It may not always be easy to handle the problem of sleep enuresis. The parents have a responsibility to monitor the situation and intervene where necessary to help their child reach a level of physical maturity where their bladder muscle becomes strong enough to handle enough urine to keep them clean in bed. It is essential for this guidance to be conducted without making the child ashamed of something they cannot control. For this reason, we have filled this article with information about how sleep enuresis works and how to deal with it efficiently and without fuss. Let’s get into it.
How Does Sleep Enuresis Work?
One of the alternate names spells it out quite well: involuntary urination, in this case during the night while the person is asleep. There are two main types of sleep enuresis to consider when it comes to causes – primary and secondary sleep enuresis. Primary enuresis is the most common type, as it is characterized by the person having had that issue since birth. This is typically what you’d see in children, who start wetting themselves as babies. This category of bedwetting is traditionally caused by the brain’s inability to wake the child up at night for a quick bathroom trip, or the bladder itself not developing enough to be stable during the night. Luckily, both of these issues are easily outgrown given enough time.
Secondary enuresis happens much less often, which is why it often goes overlooked. It is a condition that can pop up anywhere from six months to several years after the person develops the ability to control their bladder properly. Despite normally being seen as an issue only children (and through them, their parents) face, bedwetting affects around 1-2% of teens in the United States. If a person older than the age of 6 or 7 has sleep enuresis problems, it becomes necessary and important to consult a doctor.
There are multiple potential causes of sleep enuresis. The key word here is “potential,” as not even researchers can clearly outline the exact causes in most cases. Still, we have a list of possible causes and contributing factors that can affect children and adults. Knowing about these factors is important for providing proper care for the person dealing with involuntary urination. Here’s the list:
- Hormonal problems can cause sleep enuresis. There is a special compound called antidiuretic hormone (ADH) whose job it is to significantly lower our urine production while we’re asleep. However, some people simply do not produce enough of this hormone, which can cause involuntary urination.
- Bladder issues can be common across the board when it comes to different age groups. Children don’t have properly developed bladders until at least age 5, which can (and often will) lead to nocturnal enuresis. For children especially, a common cause can be the brain’s inability to interrupt sleep when it comes time for a midnight bathroom trip (we say midnight because involuntary urination often happens only 2-3 hours after the person falls asleep). The bladder communicates that it’s full to the brain, but the response isn’t adequate. Adults and teens sometimes simply have small bladders, which cannot hold that much much urine before they automatically lose control and relieve themselves.
- Genetics can sometimes make a difference on their own. Studies have shown that teens who experience sleep enuresis tend to have a parent who had the same problem at their age.
- Psychological issues are a recently-established potential cause of bedwetting. Stress, in particular, has been linked to increased urges to urinate, which can translate into nocturnal enuresis according to some experts.
- Medical conditions such as constipation, diabetes, urinary tract infections (UTIs) and urinary tract abnormalities or deformities can all cause secondary sleep enuresis. The latter is characterized by problems in the structure and functionality of the person’s urinary tract. It is one of the leading causes of secondary sleep enuresis for teens and adults. More severe conditions such as bladder cancer or prostate cancer often cause bedwetting, too.
- Sleeping disorders and problems can cause nocturnal enuresis. Certain conditions can prevent the person from waking up when they have to relieve themselves, even if they would normally be able to do so. Depending on what the underlying disorder is, different solutions are available for this. However, some sleep medication can also make it harder to wake up and urinate properly, along with other potential side-effects.
Diagnosing Sleep Enuresis
The best and most practical course of action when dealing with sleep enuresis (whether it’s you, your child or another family member) is to simply consult a doctor as soon as possible. They are way more prepared to offer an accurate and helpful diagnosis and set the patient on the right path in terms of treatment. Depending on the patient’s age (note that sleep enuresis typically isn’t diagnosed in children under the age of 5) and other potential parameters, different diagnostic methods can be used. In general, however, you should expect to see one or more of the following options:
- A basic physical examination is almost guaranteed to take place when someone is inspected for signs of sleep enuresis and general urinary issues.
- A neurological examination
- Urine sample analysis and urologic examination
- In some cases, a full ultrasound inspection of the patient’s kidneys and bladder may be necessary. This method can help uncover conditions such as bladder cancer for adults.
No matter which of these methods are used, a detailed medical history is also required. The doctor will ask you about your (or your child’s) urinary patterns, sleeping patterns, past medicine use, allergies, etc. Additionally, they will ask about daily stress and anxiety levels, since those mental problems can contribute a lot towards involuntary nocturnal urination. Give as much detail as you can, because all of it helps reach an accurate diagnosis.
Treating and Coping With Sleep Enuresis
Fortunately, the vast majority of treatment options for involuntary nocturnal urination have no significant side-effects aside from occasional sleepiness. Depending on who’s being treated, many methods usually boil down to behavioral planning and timely interventions by others in the household. Medication is only prescribed as a last resort in most situations. Let’s look at the most common methods used to treat patients with sleep enuresis, especially children:
- Because bedwetting often occurs in the first couple of hours after the person falls asleep, someone else in the house can either set an alarm or stay awake long enough to wake them up right before they normally have a tendency to wet the bed. Some alarms use a “bell and pad” system to automatically detect moisture in the patient’s sleeping clothes or on the bed under them, and wake them up upon registering enough moisture. The ultimate goal of this method is to train the person to automatically wake up early enough to relieve themselves in the bathroom properly.
- Establishing a strict and reliable sleeping routine can do wonders for the person dealing with sleep enuresis. It is important to include regular bathroom trips in this routine. If you combine this method with the previously mentioned alarm systems and assistance waking up, you can prepare yourself, your child or another loved one to wake up properly to relieve themselves.
- Avoid drinking a ton of liquids before bed. A no-brainer, perhaps, but it’s often hard to notice exactly how much water or other drinks you consume, as they’re a deeply ingrained part of our daily routine. It’s a common habit to have a glass of water right before bed, to avoid dry mouth situations that can cause minor discomfort. Try to avoid this habit.
- Parents of bedwetting children can establish reward charts and introduce healthier meals that promote dry nights and reduce the risk of involuntary urination. Rewarding your child for waking up to go to the bathroom can increase how often they follow that behavior pattern, even if they’re not aware of it.
- If all else fails, doctors may prescribe some medication. One of the best options is a manmade dose of antidiuretic hormone (ADH), which can compensate for the potentially reduced ADH production level in the body, and force the body to produce less urine, preventing sleep enuresis.
Treatment is one thing, but there are ways to simply improve the bedwetting situation and help your child through it emotionally. One pitfall that a lot of parents fail to avoid is that you should never, under any circumstance, criticize, scold or punish your child for wetting the bed. They cannot control their bladders properly, so the problem is out of their hands, so to speak. Being too strict can seriously hurt the trust your child has for you, as it can feel like you’re punishing them for something they didn’t do. Be comforting and friendly when talking to your kid about bedwetting, and help them avoid feeling ashamed or embarrassed. You (and your spouse) are the only people this child can rely on, so be understanding. Also, avoid talking about their problem in front of other people, especially if the child dislikes those people for whatever reason (for example, sometimes a family member will tease your child in a friendly way, but that joking manner may not be interpreted as such by the child, causing mistrust and avoidance).
You can make a clever investment and buy disposable or reusable absorbent underpants. These can save you a lot of effort cleaning up messes that occur as a result of bedwetting and don’t interfere with the functionality of moisture alarms.
Co-founder of Counting Sheep and Sleepaholic