What is enuresis?

Enuresis is the medical term for the involuntary passing of urine. It may happen at night in children and then is called bedwetting or nocturnal enuresis.

The strict definition of nocturnal enuresis is bedwetting over the age of five years. It may be primary, when a child has never developed bladder control or secondary when a child starts to wet the bed again after having been continually dry for more than six months. Bedwetting is common in children. Approximately one in ten of all five year-olds and one in twenty of 10 year olds wet the bed. It is more common in boys.

In the majority of children who wet the bed no reason can ever be found for the problem. It may sometimes run in the family. Around two thirds of children with nocturnal enuresis have a brother, sister or a parent who has had the same problem. Rarely there may be medical, social or psychological factors such as constipation, kidney disease, urinary tract infection, diabetes, food allergies, or even problems at school or at home.

Are alarms or drugs useful?

The use of bedwetting alarms and or medicines can be successful in cutting the number of wet nights but neither is a cure for the problem. Alarms are cumbersome, noisy and always wake everybody else in the family. A lot of dedication is needed to use a buzzer alarm successfully. All the medicines that have been tried must be prescribed by a doctor and the response monitored regularly, and they all have side effects.

Practical actions

Most children are embarrassed about wetting the bed and it is very important to make sure that each child really understands that it is a common problem and that there is nothing wrong with them. Involving the whole family in the management of bedwetting can be a good idea but it is vital to be relaxed and avoid stress and confrontation.

It does help if the family supports the child and shows a positive attitude. The child should not drink for a good while before bedtime and it is important to make sure that they go to the toilet before getting into bed. It is a good idea to protect the bed by using a waterproof mattress and to put some clean nightclothes and sheets next to the bed so the child can change if they wake up.

Sometimes taking the child to the toilet at night to empty their bladder is really helpful, but the way this is done is important otherwise things will not improve. A parent or the child can keep a diary or spreadsheet and record dry and wet nights. This form of encouragement is often a helpful way in dealing with the condition. Keeping a record of success is very important particularly when reviewing progress.

Effective management

There is really no point in trying to deal with bedwetting in a child aged less than five years old. The essence of good treatment is to find a doctor who has the time, patience and experience to deal with this common condition properly. All too often the child is sent to an enuresis clinic, and it is not unusual for an alarm or medicines to be prescribed without anyone fully understanding the nature of the problem.

A kind and understanding approach to both the patient and the family is essential when taking the medical history. A careful examination of the child is important, explaining what is happening as the examination takes place. If any tests or investigations necessary these must also be carefully explained. Bed wetting does get better with time. It is a nuisance but the majority of children can be helped overcome the problem in a positive and very rewarding way.