Nocturnal Enuresis (Bedwetting)

• Nocturnal enuresis or bedwetting is intermittent night-time urinary incontinence.  
• Relatively common in children.  
• 5-10% of children at seven year of age may continue to have bedwetting.  
• Primary – when child has never been dry for at least six months.  
• Secondary – when child initially achieved dry period of more than six months and started wetting again.
• Bed wetting has significant secondary stressful, emotional and social consequences for the child and their caregivers.
• Boys are known to have more chances of bedwetting than girls at any age.  
• Hereditary factors are known to influence this condition.  History of bedwetting in either or both parents significantly increase the chance of having bedwetting in child.

Causes of bedwetting

• High arousal threshold – child does not wake up when bladder is full.  
• Imbalance between night time urine output and bladder capacity.  
• Alteration in chronobiology of micturition in which circadian clock in kidney, brain and bladder is disturbed.
• Symptoms such as habitual snoring, apneas, excessive sweating at night and mouth breathing leads to secondary bedwetting.  

Diagnostic tests

• The diagnosis is mainly made by history-taking.  
• Complete two to three days fluid intake diary and voiding diary is recorded to rule out any urinary tract pathology and excessive water drinking habit.  
• Night time urine output can be recorded by measuring wet diaper weight.  Excessive night time urine production is calculated measuring diaper weight used night time.  
• Urine examination for infection.  
• Physical check up by doctor.  
• Ultrasound and urine flow test (uroflowmetry) if prior surgery was done or suspecting urinary tract pathology.  
• Checkup by ENT doctor if sleep disorder breathing present.      

Treatment

• Many children stop bedwetting with age; so wait and watch can be observed for age upto five –six year age.  
• Normal and regular drinking habits with bowel and bladder habits are encouraged.  
• Wetting alarm system – use of a device that is activated by getting wet. The goal is that the child wakes up by the alarm, action is to repeat the awakening and therefore change the high arousal to a low arousal threshold. High success rates are noted with this therapy.  
• Medical therapy – Used in children with high urine output at night. Desmopressin tablet or sublingual tablet is used. Imipramine is another commonly used drug.