Sleep enuresis – bedwetting

Sleep enuresis or nocturnal enuresis is a specific disorder which is characterized by the persistent bed wetting during the sleep without any organic pathological cause after the age of 4-5 years.
Most children are toilet trained during daytime between the ages of 2 1/2 to 5 years, and night training usually follows about six months later. It is also called Enuresis nocturna, nocturnal bed-wetting, primary enuresis, familial, functional idiopatic, symptomatic, or essential enuresis, night-wetting…

Prevalence

It is estimated that 15-20% of children wet their beds at age 5, about 5% at age 10, 2-3% at age 14 and 1-2% in young adulthood. It is slightly more common in younger boys than girls, but the ratio increases to 2:1 around age 11. 

Types of sleep enuresis

• Primary enuresis refers to inability to maintain urinary control from infancy.
• Secondary enuresis is a relapse after control has been achieved.

Possible causes of sleep enuresis

There are many theories as to what causes enuresis.

Genetic causes
There is no doubt that genetic or familial factors play an important part in many children. When both parents have, or have had enuresis, there is a higher chance that the children will have it too.

Emotional disturbances
Underlying emotional disturbances, behavioral (ADHD, dyspraxia etc.) and learning difficulties are all considered to play some role in the ethiopathogenesis of sleep enuresis.
 
Sleep and other disorders
Sleep depth arousal levels, a small bladder capacity, nocturnal polyuria, dysfunctional detrusor muscle or dysfunctional perineal muscles may all be the contributing factors.
Medical disorders like diabetes, urinary tract infection, sleep apnea or epilepsy as well as some psychiatric disorders can also cause it.

Stress
Stress and illness may also play a significant part.

Diagnosis and prognosis for bedwetting

There are specific criteria for diagnosing sleep aneuresis: there have to be at least two episodes per month in children 3 to 6 years old and at least one episode per month for older individuals. Sleepwalking can also occur during an episode. The doctor may check for signs of a urinary tract infection, constipation, bladder problems, diabetes, or severe stress.
There is no doubt that bedwetting usually goes away on its own. The problem is that, until it does, it can be embarrassing and uncomfortable for almost any child. That’s why parents play a major role and it's a good idea to reassure a child that bedwetting is a normal part of growing up and that it's not going to last forever.

Treatment of sleep enuresis

Although most of the times this condition resolves by itself,unfortunately, no one can tell how long it may take to reach that point. Approximately 20% of children cease the bed-wetting every year without treatment. Therefore, in the majority of cases, no treatment is necessary. The decision to treat a child should be made jointly by the family, patient, and a physician.
In general, treatment is used for relatively older children, those with secondary emotional problems, and children with more severe (frequent) enuresis. It is important to understand that no universally accepted treatment of enuresis is 100% successful. A full physical examination should be done to rule out other medical conditions. Various techniques can be used when other medical conditions have been ruled out.

The most common are:

• behavior modification,
• alarm devices,
• medications