Nocturnal Enuresis


How common is Nocturnal Enuresis?

Nocturnal Enuresis

Nocturnal Enuresis is most common amongst children. About 30% of children around 4 years old still wet the bed with doing this 21% and 8% of these more frequently. By the age of 7, this falls to approx. 2.5 of children wetting their bed on two or more nights per week. Nocturnal Enuresis is also far more prevalent in boys, with a ratio of about 2:1 against girls.  Children with more frequent wet nights are more likely to have a persistent problem and benefit from early identification and investigation.

Nocturnal Enuresis is estimated to affect about 1 adult in 100. Most people think that no one else has this problem. Many people never seek help because they are too embarrassed.

Bedwetting causes many practical problems, such as constantly having to change wet sheets and bedding. Bedwetting can affect staying away overnight, going on holiday or business trips. Bedwetting can affect sleep patterns and often it causes frustration and exhaustion.

What is Nocturnal Enuresis?

Nocturnal Enuresis means wetting the bed. Some people wet the bed regularly all their lives. Others grow out of this during childhood but start again later in life. It can even happen if you doze off on a long coach or train journey.

What Causes Nocturnal Enuresis?

The causes of Nocturnal enuresis remain unclear.  Typically people produce less urine when they are asleep. However, some people produce larger amounts of urine during the night, which may explain why the bladder needs emptying then.  Research has shown that nocturnal enuresis may be due to genetics with evidence showing that bedwetting may be hereditary. People with two bedwetting parents has a high chance of also becoming a bedwetter.  Though this drops significantly when only one parent wet the bed as a child, this still resulted in a 40% probability of their child becoming a bedwetter.

Another proposed cause for nocturnal enuresis is a smaller than average functional bladder capacity. The functional bladder capacity is the amount of urine the bladder holds before sending a signal to the brain to indicate the need to void. Overactivity of the bladder (detrusor) muscle indicates that the muscle is never fully relaxed during the filling phase and therefore the bladder capacity is not as large.

People with 'overactive' or 'unstable' bladder (otherwise known as Urge Incontinence or OAB) may often find this causes problems at night as well as during the day. Several studies have found a high incidence of overactive bladder (Detrusor Instability) with nocturnal enuresis, with some studies find  Detrusor overactivity in up to 80% of nocturnal enuresis patients.

The amount and type of drinks that you have is important. We all need fluids to stay healthy, but some drinks can irritate the bladder or make the body produce urine more quickly than usual. Alcohol, and drinks that contain caffeine (such as tea, coffee, hot chocolate and cola), can affect you in these ways.

Some medicines prescribed for completely unrelated problems can change the way your urinary system works and can cause you to have less control than normal. These medications include common drugs used for heart and blood pressure problems, or for mental illness and anxiety.

An infection in the urine (urinary tract infection, "UTI") can sometimes cause bed wetting. Stress or anxiety can also cause the problem, which might last long after the stress has gone.

If you start bed wetting again as an adult and this persists, it could be the result of a more serious underlying problem. If this is the case, you need to go to the doctor immediately for further investigation. The right advice and support can help people who have this problem. Bedwetting can often be cured. It is always worth seeking help even if you feel you have already tried everything.

Diagnosing Nocturnal Enuresis

To diagnose an incontinence condition, your health professional should ask about your symptoms and medical history. You may be asked to keep a ‘bladder diary’ for a week or so. This should record your fluid intake (what and how much you drink) and fluid output (the amount of urine you produce, and when you pass urine), whether you had an urge to urinate and the number of times you unintentionally pass urine. For Nocturnal Enuresis so specific questions that may be asked are:

  • Whether there are any daytime symptoms (abnormal frequency of urination (either too frequent (more than seven times/day) or infrequent (less than four times/day)), urgency or daytime wetting.
  • Whether the person has previously been dry at night without assistance for six months. If so, are there any medical, physical or environmental, social or emotional causes or triggers for the change.
  • How many times a night and how many nights a week?
  • Do there seem to be large quantities of urine in the bed?
  • Is there any pattern - what time does bedwetting occur?
  • Does the person wake after wetting the bed?
  • What is the daytime pattern of toilet use?
  • Is there also constipation or soiling?

 They may also carry out a test on a sample of the urine to check that the incontinence isn’t being caused by a secondary cause such as an infection in the urinary tract.

How can I manage Nocturnal Enuresis?

For children there are some straight forward strategies such as rewarding dry periods or lifting during the night. You may find that rewarding agreed behaviour (e.g., drinking adequately, using the toilet before bedtime, avoiding caffeinated drinks, etc.) may be more effective than rewarding dry nights, which are out of the child's conscious control.   If the child wakes at night, encourage them to use the toilet before returning to sleep. Harmful approaches, such as fluid restriction, should be avoided.   

If the child is under 5 years old, and doesn’t have day time symptons then typically the condition resolves over time without treatment. If the child or person is over 5 years old or has daytime symptoms then it is likely that treatment will be more involved. It is important to discuss this with a qualified health professional to identify that the Nocturnal Enuresis isn’t caused by another condition (e.g. urge incontinence) and therefore the primary condition needs to be treated. If the condition is found to be purely Nocturnal Enuresis then it is likely that Alarm Training will be considered as a first-line treatment before evaluating other options such as medication. 

No matter what type of Incontinence you or the person you care for is experiencing it is important you discuss this with a Health Professional. Incontinence is often a symptom of an underlying condition and in many cases simple steps can help improve the condition.