Bedwetting (Enuresis)

Bedwetting is the involuntary release of urine into the bedclothes at night.

What Is Enuresis?

Enuresis (en-yoo-REE-sis) is the involuntary, unwanted release of urine either in the day or at night in people who are old enough (around ages 5 to 6) to have gained bladder ^* control. Bedwetting is a specific kind of enuresis that occurs at night during sleep. Most young children accidentally wet the bed occasionally, and this is normal. About 10 percent of six-year-olds still wet the bed, but only about 1 percent of adolescents experience enuresis. Bedwetting becomes a problem when it happens repeatedly in older children. In older children, bedwetting limits social activities and can be stressful and humiliating. It can contribute to psychological and emotional problems such as low self-esteem ^* and depression ^* .

Why Do People Wet the Bed?

Doctors are not exactly sure why some people experience problems with bladder control and others do not. They do know that bedwetting runs in families and that more boys than girls have this condition. Many children who wet the bed seem to sleep so deeply that they are not awakened by the urge to urinate. Recent research suggests that some people who wet the bed may produce less antidiuretic hormone (anti-di-u-RET-ik HOR-mone), or ADH, than do people who do not have enuresis. ADH regulates how concentrated the urine is. People generally produce more ADH at night, allowing them to create a smaller volume of more concentrated urine while they sleep. People who produce less ADH at night will produce more urine that is less concentrated (more diluted).

Bedwetting is sometimes related to medical problems such as infections of the urinary tract, sickle-cell anemia ^* , diabetes ^* , epilepsy ^* , or an improperly formed bladder. However, most people who wet the bed do not have medical problems and have normal-sized bladders. Occasionally bedwetting is linked to psychological problems, especially if a person has previously stayed dry at night. Stress from the birth of a sibling, divorce, or death in the family may all cause a (usually temporary) period of bedwetting, especially in younger children.

How Is Bedwetting Treated?

Most children simply outgrow bedwetting. Bedwetting in older children can be treated in different ways depending on what is causing it. First, a doctor does a complete physical examination to determine if bedwetting is caused by a medical condition. If it is, the underlying condition is treated medically with drugs or corrective surgery. However, only a very small number of adolescents who experience bedwetting have an underlying medical condition that is responsible for the problem.

If the bedwetting appears to be caused by emotional or psychological stress or depression, seeing a mental health professional is the first step to resolving the problem. Counseling to help deal with the source of stress, combined with behavior modification techniques to bring about nighttime bladder control, are often very effective.

Most people wet the bed for no clear reason. These people are usually helped by behavioral strategies aimed at staying dry during the night. Behavioral modifications such as holding urine for a short while when there is an urge to urinate, rewards for dry nights, and relaxation techniques aimed at reducing stress sometimes help. The most effective behavioral technique, however, is the urine alarm. This is a pad with a bell or alarm attached to it. The pad is placed on the bed and the person sleeps on top of it. With this technique, an alarm rings at the first sign of wetness in a person's pajamas or sheets. The alarm awakens the person and allows him or her to get up and finish emptying the bladder. In time, the person's brain comes to recognize the sensation of a full bladder and wakes the person before urination occurs and the alarm goes off.

Nighttime dryness sometimes can also be achieved by the use of medication. Some medications work to affect urine concentration. Others seem to work by making it easier for a person to wake up when the bladder is full. Some medications are quite effective and work almost immediately while others may work over time. However, many people return to wetting the bed as soon as they stop taking the medication. As with all medicines, sometimes there are mild side effects to deal with as well.

Although bedwetting is not medically serious, it can have strong negative psychological effects on young people. It restricts their social lives and is embarrassing, upsetting, and frustrating. Fortunately most people can be helped to stay dry at night through a combination of the strategies mentioned above.