What Is Enuresis (aka Bedwetting)?

What Is Enuresis?

Enuresis is the medical term for bedwetting. Bedwetting happens when a child urinates in their bed at night while sleeping; however, enuresis can also happen during the day when a child or adult is awake.

Enuresis usually starts between the ages of three and five, but it can start as early as age two or as late as around eight years of age. Enuresis can happen for various reasons, and there are many treatment options available to help with this condition.

This article will explore what causes enuresis, how it is treated, and what you can do if your child has this problem.

Symptoms of Enuresis

If you are concerned that you or your child might be living with enuresis, it can be helpful to know the symptoms of this problem. Below is a list of common symptoms of enuresis for you to consider:

• Chronic incidents of bedwetting
• Incidents of wetting at least twice per week for a period of three months
• Wetting incidents involving clothing

In addition, enuresis can cause embarrassment and anxiety in you or your child. This can be especially true if you are trying to keep this condition a secret and especially if other children are teasing them about it. These feelings can have long-lasting effects and may lead to depression or anxiety over the long term.

Diagnosis of Enuresis

A diagnosis of enuresis is conducted following the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To diagnose patients with enuresis, it's important first to rule out all other possible causes. Other possible causes that will be ruled out include the following:

• Large changes in lifestyle such as diet or medication that affect bladder control.
• Medical disorders that may cause the release of urine. Incontinence can be caused by conditions such as diabetes or a blockage in the urinary tract.

If none of these changes are present and urinary accidents continue, a diagnosis of enuresis may be given based on current symptoms. Below are the diagnostic criteria according to the DSM-5 that is used when making a diagnosis of enuresis:

• Repeated wetting of the bed and/or clothing
• Incidents at least twice a week for three consecutive months or significant distress or impairment
• At least five years old
• Other potential causes have been ruled out, including general medical conditions

Causes of Enuresis

Enuresis, or bedwetting, is the uncomfortable and inconvenient occurrence—usually during sleep—of urine leakage onto clothes. There are lots of reasons why people have trouble staying dry at night. The most simple explanation is that their "bladder" (or urinary sphincter) doesn't respond to the natural signals it needs to empty. Reasons for this can include the following factors:

• Encephalitis (i.e., a brain infection)
• Psychogenic factors such as anxiety and unconscious emotions
• Medications that affect bladder control
• An obstruction somewhere along the urinary tract that interferes with bladder control
• Neurologic problems like spina bifida (a spinal defect that occurs at birth) or a back or neck injury that interfere with bladder control

Types of Enuresis

There are four types of enuresis: primary, secondary, nocturnal, and diurnal. Below are brief descriptions of each of these types. Note that enuresis can be either primary or secondary and either nocturnal or diurnal (or both).

1. Primary enuresis is when a child under 18 years old has repeated episodes of wetting their bed after achieving urinary control, which may continue over several months or even years.
2. Secondary enuresis is when an older person who was not previously incontinent begins to have problems with bladder control.
3. Nocturnal enuresis is the most common type of bedwetting in children and usually stops on its own naturally over time.
4. Diurnal enuresis, daytime wetting, usually starts at an older age and involves incontinence or physical problems.

Treatment of Enuresis

In many cases, those with waking-nighttime enuresis will grow out of it without treatment if their body is allowed enough time (an average of three years).

If not, you may want to consult with your physician about medication. Medication can be taken to reduce urine production during sleep, which will dry up the bed-wetting.

• Desmopressin acetate nasal spray or pill form
• Chlorpheniramine maleate syrup
• Oxybutynin tablets
• Alpha blockers such as apo metformin
  

Coping with Enuresis

There are several behavioral techniques for enuresis that involve changing lifestyle habits. Below are some things you can try:

• Making sure not to drink fluids too late in the evening can interfere with bladder control.
• In adults, certain foods can also be avoided that have a diuretic effect like caffeine, alcohol, and certain medications.
• Practicing bladder and pelvic floor exercises, such as Kegels, strengthen muscles that control the bladder.
• Wearing a type of diaper, typically referred to as "pull-ups," that can be pulled up and down easily if needed to avoid an accident while keeping one's dignity.
• Avoiding overreacting to the bedwetting situation. This can be counterproductive and introduce even more stress into an already stressful situation.
• Meditation techniques focusing on relaxation can help with stress reduction, which may also decrease wetting episodes.

A Word From Verywell

If you or your child is experiencing signs of enuresis, it is important to visit a doctor as soon as possible. A physician will be able to test for underlying causes and provide treatment options. Enuresis can also happen in adults with neurological conditions such as Alzheimer's disease or Parkinson’s disease, or you take certain medications that affect bladder control.

Other factors may lead to enuresis, including lack of sleep due to work/home commitments, anxiety disorders, depression symptoms, and urinary tract infections. These should be taken into consideration when assessing risk factors for enuresis occurrence. The good news is that many treatments are available to help people who have this condition live happy and healthy lives.