Bedwetting (enuresis) is the involuntary discharge of urine during sleep. It is called bedwetting after the age by which bladder control should have been established. In children, voluntary control of urination is usually present by the age of five. Nevertheless, nocturnal enuresis is present in about 15 to 20 percent of otherwise healthy 5-year-old children, 7 percent of healthy 7-year-olds, 5 percent of healthy 10-year-olds, 2 to 3 percent of 12 to 14-year-olds and 1 to 2 percent of normal children at age 15.
There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).
What is primary bedwetting?
Primary bedwetting is generally viewed as a delay in maturation of the nervous system. At 5 years of age, approximately 20% of children wet the bed at least once a month with about 5% of males and 1% of females wetting nightly. By 6 years of age, only about 10% of children are bedwetters -- the large majority being boys. The percentage of all children who are bedwetters continues to diminish by 50% each year after 5 years of age.
Emotional problems: A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting. Children who are being physically or sexually abused sometimes begin bedwetting.
Children develop complete control over their bladders at different ages. Nighttime dryness is usually the last stage of toilet learning. When children wet the bed more than twice per month after age 5 or 6, it is called bedwetting or nocturnal enuresis. There are many reasons that children wet the bed after being fully toilet trained. It might be physical, emotional, or just a change in sleep. Children who have never been consistently dry at night have primary enuresis. The child's brain has not learned to respond to the signal that the bladder is full. It is not the child's or the parent's fault.
Bedwetting complications.
Many children have problems in school caused by unhealthy deep sleep. For some it starts early and for others it becomes noticeable as the school work becomes more challenging. Often, the symptoms are similar to those associated with ADD/ADHD, (hyperactivity, socializing at inappropriate times, not being able to focus, and having a difficult time concentrating).
Treatment
Behavioral conditioning utilizing a device with a sensor that detects wetness and sets off an alarm has proved very effective. The child begins associating bladder distention with being awakened and in time "learns" to awaken before losing control. Drug therapy is considered less effective because most children relapse after stopping medication. It has its place, however. For short-term help when your child sleeps at a friend's, for example desmopressin, an antidiuretic, works well. Doctors are moving away from the antidepressant imipramine because of side effects.
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