Nocturnal Enuresis

What is Nocturnal Enuresis?

Enuresis, or else called Nocturnal Enuresis, is any leakage of urine during sleep (bed-wetting). The patient leaks urine in his sleep and realizes it only when waking up. Enuresis is considered to be normal until the age of 6 and it is  a particularly common condition. At the age of 7, 1 out of 10 children are still wetting their bed in their sleep. As age advances, the problem becomes more rare. So, at the age of 11-12 years, only 3 out of 100 kids are still having the problem. Only in very rare cases does the problem continue in puberty (1 out of 100 adolescents).

Enuresis occurs twice as often in boys than in girs.  

What are the causes of Nocturnal Enuresis?

In childhood, there may be three potential causes:

a) The child sleeps very deeply and is not able to wake up and go to the toilet as adults do,

b) In the night there is more urine output than normally.

c) During sleep, the child's bladder makes excessive contractions. 

Irrespective of the cause, the family history seems to play a major role in increasing the likelihood of enuresis in children. If one of the two parents used to wet hims/herself  during childhood, it is eight times more likely that the same will occur to one of their children. If both parents used to be enuretic, then the chances for one of the children are 16 times higher! Besides family history, it is also physical and mental retardation, as well as hyperactivity, that increase the risk. Also perinatal causes may be involved, such as preeclampsia and low birth weight. Psychological factors and behavioural disorders seem to be correlated with enuresis. Lastly, enuresis is common in patients with neurological disorders both in children and adults. 

What are the types of Nocturnal Enuresis?

Primary Enuresis is the condition when the patient has not been fully dry during sleep for at least a period of 3 months. Secondary Enuresis  is the condition when the patient used to remain dry in the past for at least a period of 3 months. If enuresis is observed only at night, then it is called monosymptomatic. However, in half of the cases nocturnal enuresis goes together with urinary incontinence during the day. In this case, we have non-monosymptomatic nocturnal enuresis.

What is the treatment of Enuresis?

Treatment of Nocturnal Enuresis is indicated after the age of 6. Before applying any kind of treatment, thorough examination and screening has to be carried out by the Pediatrician. A very useful tool in determining the most appropriate therapy is the urinary diary. Parents help kids by measuring and writing down the urine output released during both night and day. Also, the quantity of liquids consumed by the child and the exact timing. In this way, the physician can understand whether enuresis is due to high production of urine during the night or due to small bladder capacity. It is more useful when the urinary diary is filled in for at least 3 days and nights. 

The simplest and intitial measures taken to cope with the problem of nocturnal enuresis are: a) waking the child with the use of an alarm clock as a reminder to go to the toilet and b) limitation of excessive fluid intake before sleep. Kids usually need to be motivated so that the therapy brings results. As long as the above measures are followed properly, they are the most successful therapy. At least 7 out of 10 cases are resolved in this way. In case the initial measures fail, there are pharmaceutical agents for reducing nocturnal urine production, as well as for decreasing bladder contractions during sleep and increasing bladder capacity. Drugs reducing nocturnal urine production usuallly act fast and are impressively effective but, in case of abrupt discontinuation, may lead to relapse. Drugs decreasing bladder contraction during sleep and increasing bladder capacity are recommended mainly when children wet themselves during both day and night. Pharmacotherapy should be combined with bladder re-education instructions during the day. In most difficult cases, combination therapy is followed. 

Nocturnal Enuresis in adults requires specialized monitoring and treatment, for it cannot be resolved following common treatments. Also special therapeutic approach is needed for patients with neurological disorders. Radiological screening and urodynamic testing may be recommended by the physician for deciding on the most appropriate therapeutic treatment.