The phenomenon of bedwetting, or sleep enuresis, occurs commonly and fortunately can be effectively treated.
What is Bedwetting?
Bedwetting, or sleep enuresis, involves the involuntary loss of urine while asleep. It is deemed to be a problem when it occurs twice per week beyond an age when voluntary control should be present, which is generally defined as 5 years old.
It more commonly occurs in younger boys. Bedwetting may be present in 3-30% of children aged four to 12 years. It also occurs in about 2% of adults. It typically happens during deep sleep.
Different Enuresis Types, Different Causes
There are two types of bedwetting. The most common type, called primary enuresis, occurs if dryness during sleep is never accomplished. Alternatively, secondary enuresis is the recurrence of bedwetting after being dry for at least a 3-month period and this accounts for about 10% of bedwetting.
Primary enuresis is due to a failure to awaken from sleep when the bladder is full. It may also result when the bladder inappropriately contracts during sleep causing urine to leak.
There are many potential causes of secondary enuresis. It may be due to various medical conditions that lead to an inability to concentrate urine or even increased urine production. Problems of the urinary tract, neurologic system, or even sleep disorders like obstructive sleep apnea may also contribute. Stress as well as caffeine and diuretic use may also cause bedwetting.
Getting Diagnosed and Treated
It is important to identify any other disorders that may be contributing to bedwetting. A primary health care provider can conduct this evaluation. Usually it is not necessary to have a polysomnogram or other sleep study unless sleep-related epilepsy (such as nocturnal seizures) or obstructive sleep apnea is suspected.
There are a variety of effective treatment options available. Some of these include behavior modification techniques. For example, scheduled awakenings during the night to empty the bladder can be helpful. In addition, some individuals respond well to a therapy called retention control training. This is meant to increase the capacity of the bladder.
There are also a variety of urine alarm devices that can also be used. These products sense moisture and buzz or make noise to interrupt the bedwetting episode. Finally, the medication desmopressin, used at bedtime, is effective in reducing bedwetting. It may be administered in nasal spray form or taken orally, which is the preferred treatment.
Mowzoon, N et al. "Neurology of Sleep Disorders." Neurology Board Review: An Illustrated Guide. 2007; 742-743.