Nocturnal Enuresis is defined as spontaneous emptying of the bladder during sleep occuring in children 5 years of age or older. In the USA this affects 5-7million children.
Restricting the amount of fluids given before bed,and/or toileting the child before the parents retire has little or no effect on this.
Medications are rarely appropriate before the age of 7 years and generally if the child is not distressed it is wise to wait and see if this does resolve over time. For many children resolution is a matter of maturity and by the time they have reached 7 years there is no problem.
If the child is 5 years old and distressed by wetting the bed then it is possible to look at methods of training the bladder. Studies show that the use of Enuretic alarms combined with behavioural therapies are effective when the child is motivated. Children should not be made to feel guilty about this problem and they should be reassured that it can be resolved.
There are a variety of theories about the cause of bedwetting and these are probably the most familiar;-
1) That there is a difference between the bladder's capacity and the production of urine overnight.
2)That the child sleeps so deeply that the normal "alert" of a full bladder is not disturbing.
3) That the child's bladder is smaller and with maturity this will change.
Various factors can potentially influence the balance between nocturnal urine production and functional bladder capacity. Different types of bladder dysfunction, resulting in a small nocturnal bladder capacity, probably contribute significantly. As different clinical subgroups may have different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made. New insights have an important bearing in our future management strategy for bedwetting
If you would like help and advice in dealing with this problem,
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