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Every night across America, 5 to 7 million children are turning off the lights, going to sleep, and wetting their beds. The medical name for bedwetting is enuresis - "the involuntary voiding of urine beyond the age of anticipated control" - and it's a common condition in children and adolescents The term sleep wetting or night wetting would make more sense than bedwetting. The child wets because he or she is asleep, the bed gets wet only if the there is no use of nighttime protective, absorbent garments.
Enuresis, like all incontinence is a symptom, not a disease, and it appears to have a number of causes. It is also very stressful for both parents and children. For the child wetting the bed, it's often a major embarrassment. For parents, there may be a mixture of annoyance and sometimes a little anger. They wonder if bedwetting is done on purpose or because of laziness. Understandably, most children think that they are the only ones who sleep-wet .The most common cause is probably slower than normal development of the bladder and nervous system in many children.It is also gnetic in some way. If one parent wet the bed, the child's chance of bedwetting is 25%. If both parents were bedwetters as children, their child's risk is approximately 65%. Scientists have discovered a gene for enuresis. Recent medical research, however, has found that many children who wet the bed may have a deficiency during sleep of an important hormone known as antidiuretic hormone (ADH). ADH helps to concentrate urine during sleep hours--meaning that the urine contains less water and is therefore of decreased volume. This decreased volume usually means that their bladders do not overfill while they are asleep. Testing of many nightwetting children has shown that they do not show the usual increase in ADH during sleep. Enuretic children often produce more urine during the hours of sleep than their bladders can hold. If they do not wake up, the bladder releases the urine and the child involuntarily wets.
At night the brain sends a chemical message to the kidneys to tell them to shut down most of the sifting so not so much urine is produced. The urine produced by the kidneys flows down tubes to the bladder which acts like a balloon. As it fills with urine it enlarges and stretches and when full it sends a message to the brain. During the day this signal is felt and the child goes to the toilet. If he or she fails to recognise the signal when asleep the bladder has no choice but to relax and let the urine out, resulting in a wet bed. The bladder is a balloon-like muscle 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 made 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 muscle below the bladder (pelvic floor muscles) can contract to keep urine back. Bedwetting can happen when any part of the system does not operate correctly at night.
In the end though, experts are not sure what causes nighttime incontinence. Kids who experience nighttime wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.
In 1950, primary nocturnal enuresis was linked to sleep disorders. It was the thinking at the time that wetting occurred in a very deep sleep or on transition from one stage to another. Evidence now points to the fact that wetting occurs in all stages of sleep and is proportional to the amount of time spent in each stage. Urodynamic studies show that the bladder empties when maximal capacity is reached. Clinically over the years, it has been observed that the majority of parents state their child is "very hard to awaken" or "nothing wakes my child up." The search for evidence for impaired arousal as a cause for enuresis has not been successful, however. In fact, the evidence for arousal differences between enuretics and controls shows that wetting is not related to sleep pattern, depth, or arousal.
An estimated 25% of all five year olds regularly wet the bed, but more surprisingly, 6% of all sixteen to twenty year olds also suffer from nocturnal enuresis but few are aware of this fact. Teenage enuretics find their condition too embarrassing to own up to and often believe they are dirty, immature, or are otherwise somehow to blame. Because few teenage cases are seen by GPs these sufferers are unaware of the actual prevalence of nightwetting in adolescents and are also ignorant of the fact that enuresis is a serious but treatable medical condition. There is an estimated 130,000 teenage bedwetters in Britain, a nation barely larger than our state of New York. Its occurence borders on common. Bedwetting, however, is still viewed as a trivial condition affecting only babies and children, and the mere mention of wetting the bed almost always raises a wry smile; after all it’s not exactly in the same league as some other illnesses. However, this relaxed attitude means that some enuretics carry the condition from childhood well into their teens in silence and never visit their GP for treatment. This feeling of helplessness and extreme embarrassment can cause a variety of deep-seated psychological problems as teens find personal relationships difficult for fear of their ‘secret’ being discovered. Nightwetting can lead to self-imposed isolation. Typically, teenage enuretics are withdrawn and suffer from very low self-esteem and lack of confidence.
Dr Richard Butler is a consultant clinical psychologist at High Royds Hospital, West Yorkshire, who specialises in the psychological effects of enuresis. Butler says, “ I feel bedwetting is without a doubt a distressing experience for children. It can worsen into adolescence where the young person is faced with the conflict of increased social opportunities, autonomy and independence, yet troubled by a sense that the problem will never be resolved. Young people are faced with daily reminders of their problem which can have a severe impact on mood with guilt and shame; self-esteem - feeling different from others; social development - withdrawing from others, not participating in social activities, being unable to talk to others about it, avoiding parties, outings and leaving home; and their relationship with parents who may become increasingly exacerbated and helpless. I’ve even had individuals contemplate suicide as a means of ending the torment.”
"Most parents have tried waking their children up during the night to urinate (not an easy task), but often they are still wet in the morning, and everyone is exhausted," says Sandra Hassink, M.D. of the duPont Hospital for Children. "Most also try fluid restriction (sometimes to extremes), and their children are wet the next morning - and thirsty all night. We do not stress these types of techniques. We want children to sleep through the night or awaken on their own. We do stress common sense with the amount of fluids at night, plus avoiding caffeine." According to Dr. Hassink, enuresis almost always resolves on its own and is not the child's fault. "Success in enuresis treatment depends on a motivated child. Though they might not know 'how' to change their sleep behavior, dry nights can be achieved. We stress that almost no one wets the bed on purpose. After all, it's often embarrassing and uncomfortable. Punishments have no place in the treatment of sleep-wetting, and can make the problem worse. If there is to be success, family support and positive reinforcement are vital."
"Most of the children seen in our clinic wet 7 nights per week," Dr. Hassink says. "Some wet multiple times per night. Still, they can become successful at staying dry. Understandably, most children think that they are the only ones in their class who sleep-wet. We emphasize to them that others also sleep-wet, but since most children aren't likely to discuss sleep-wetting with their friends, it may feel as though they are the only ones with the problem." It is helpful to let a child know about other family members who used to be wet but are now dry. “
Parents should discuss sleepwetting with their child's doctor. A history, physical exam, and urinalysis screening are important first steps - and usually show completely normal results. Many hospitals have established clinics to help treat the problem. If your child does not have an identified primary physician, the National Kidney Foundation maintains a physician referral service of physicians nationwide who have indicated an interest in caring for patients with bed-wetting. This referral service can be reached at 1-800-622-9010.
According to The Canadian Paediatric Society sleepwetting does not always need to be treated. The most important question to ask when considering whether to treat the bedwetting is: Is the bedwetting a problem for the child?
Major Causes of Night Wetting:
1. Hormone level may be inadequate to suppress kidney output during night.
2. Depth of sleep can affect how bladder contractions are communicated to or received by the brain.
3. Underdeveloped or small bladder for age results in low bladder capacity relative to kidney output.
4. Poor muscle tone in the outer sphincter or pelvic floor muscles can reduce the ability to resist bladder contractions and cause urgency or leakage.
5. Immature or damaged nervous system may leave pathways to the brain unresponsive for control when asleep.
6. Anatomical irregularities in size, shape, and/or location of urethra and sphincter muscles can cause incomplete voiding, leakage, or urgency.
7. Premature wave contractions in the bladder walls result in feeling the need to empty the bladder before it is full.
Contributing Factors to Night Wetting:
1. Allergies and chemical reactions including hay fever, milk, caffeine, medications,tropical fruit, spicy foods, etc. may increase kidney output, irritate bladder lining, or decrease bladder capacity.
2. Constipation and full bowels can put pressure on bladder reducing capacity.
3. Urinary tract infections may lead to bladder irritation and incomplete voiding.
4. Not enough liquid intake can result in strong concentrated urine that irritates the bladder and leads to urinary tract infections.
5. Sleep patterns such as lack of sleep, excessive tiredness, early or irregular bedtimes can affect kidney output and depth of sleep.
6. Snoring or sleep apnea can reduce oxygen in the blood stream affecting sleep and reaction time.
7. Tension and stress can irritate bladder, reduce capacity, and impair parts of the nervous system that handle bladder control.
Information for kids about wetting from the nemours foundation
Main Code of Beliefs Information Parents Support