Commonly known as bed wetting, sleep enuresis is typically associated with young children. However, the condition is also known to be present in aged adults also. Bedwetting is effectively a type of parasomnia, which in turn refers to activities or actions that occur during sleep. The unconscious or involuntary action of urinating during sleep are generally associated with the inability to wake up in time to empty the bladder. While this condition is more of a developmental activity in kids, it is a medical condition in adults who have bed wetting problems. Here is all that you need to know about bed wetting, and the treatment options presently available.
Why do children pass urine while asleep?
The reflex action of urinating occurs in infants during sleep as well as when infants are awake. This condition continues in infants for as long as one and a half years of age. After the child crosses this age, there is a conscious effort to control or delay urination when awake. This gradually moves on to the age where the child learns to control urination while asleep. This is part of growing up, and indicates the extent of developmental maturity achieved in the child. Complete control of urination while awake and while asleep are typically achieved when the child attains five years.
What causes bedwetting during sleep?
The amount of urine produced in the body is related to the hormone vasopressin. Produced in the pituitary gland, this hormone regulates the production of urine in the kidneys. The pituitary gland increases the production of vasopressin when an individual is asleep. Consequently, the trips to the washroom are reduced considerably as the amount of urine produced is significantly lower. One of the reasons for primary bedwetting among children is the lack of increased production of vasopressin. Consequently, the amount of urine produced is relatively more, resulting in filled bladders. Children who fail to wake up despite having a filled bladder, end up wetting their beds.
Commonly associated symptoms with bedwetting
Not all instances of passing urine on bed can be termed as bedwetting. Instances of urinating in bed can be considered as bedwetting in children above the age of 5 years when the child passes urine in sleep at least twice a week. There could be other reasons for bedwetting, and it is necessary to understand the underlying cause. For instance, urinating in bed is also associated with certain medications, other medical conditions, abuse of substances, sleep disorder, or mental health condition.
The possibility of children passing urine on bed depends on various factors and is broadly classified as statistics. Around 10% of children of the age of 6 are likely to experience bedwetting. Around 7% of children in the age group of 7 years, are known to pass urine in bed. In the case of 10 year olds, the percentage of children wetting their beds is around 5%, while it is 3% in the case of children around 12 years of age. Prevalence of sleep enuresis among 18 year olds is around 1%. Additionally, the prevalence of bedwetting is higher in boys and lesser among girls.
Other related information
There is a distinct link between bed wetting and genetic traits. For instance, if either of the parent had bedwetting issues as children, the possibility of their sons/daughters having the same problem is relatively strong. Children with the condition are likely to improve and come out of bed wetting problems of their own without any medical treatment or attention. Interestingly, the statistic of higher prevalence among boys than girls is reversed with age. In other words, among aged individuals, the prevalence of bedwetting is higher among women than men. It is important to understand that accidental bedwetting due to a specific condition or situation is not to be treated as primary or secondary bedwetting. This occurrence is common among children who are either part of families that do not follow proper discipline or lead lives without any developmental improvement. Similarly, children with certain disorders such as hyperactivity or attention deficit disorder are also known to wet their beds during sleep. Bedwetting occurs among children who are exposed to certain conditions that trigger parasomnia. For instance children who experience neglect or are subject to physical/sexual abuse are also likely to wet their beds. Children who are put through the difficult situation of watching parents separate are also more likely to get their beds as a result of the stress associated with separation. It is important to differentiate this from different types of abnormal activity. Children wake up from sleep and make their way to some place and pass urine. In such conditions the child does not urinate on the bed but in a location that is other than the washroom. This is a different disorder and is not to be confused with bedwetting.
Reasons behind secondary bed wetting
Multiple reasons are attributed to secondary bedwetting, which is not an age-related condition. Some of the more common causes that result in secondary bedwetting include the following :
· Certain types of diabetes
· OSA – obstructive sleep apnea
· Congestive heart failure
· Dementia
· Sickle cell disease
· Urinary tract infections
· Increase in urine production related to consumption of products with caffeine
· Increase in urine volume as a result of diuretics
· Irritable bladder syndrome
· Urinary incontinence and chronic constipation
· Epilepsy and seizures
· Stress
How bedwetting is diagnosed and treated
The diagnosis of bedwetting includes an attempt to look at the underlying cause of the problem. For instance, diagnosis is intended to understand if the individual is under any stress or medical problem that is causing the bed wetting. Similarly, diagnosis will look for the presence of sleep disorders that could be the reason behind bed wetting. The treating specialist will typically try and ascertain when bedwetting commenced, the frequency of bedwetting and all associated circumstances/conditions. In addition to medical history, the treating specialist will also need to look at the medications used in the past or the present. The session with the specialist will also look at the medical history of family members to determine if any one in the family had or has bedwetting. The doctor will also need to understand a little more about sleeping patterns as this has a direct impact on bed wetting and passing of urine during the nights.
Laboratory analysis of urine samples are also sought as part of diagnosis. Depending on the condition and the initial assessment, it may be necessary for the patient to undergo polysomnogram. This measures various parameters during the sleep cycle of the patient. It measures the heart rate, rate of breathing, brain waves, and the manner in which the limbs move when the individual is asleep. The polysomnogram study is important to assess if the bed wetting is related to other sleep disorders or conditions.
On conclusion of the diagnosis, the treatment is aimed at helping prevent bedwetting in addition to dealing with the psychological impact of the condition. After the diagnosis has ruled out certain reasons for the problem the treatment commences. Depending on the reason behind the bed wetting, treatment may include any of the following methods.
Change in behavioural methods – this is an attempt to help the individual, especially children, to move into a stage where complete control of urination is achieved. During this stage, it is necessary for parents and the immediate family members to offer the right kind of support to ensure that the child is free from all forms of embarrassment. Some of the methods used to bring about a change in behaviour include food intake restriction, waking the child during the night, alarms and rewards. For instance, it is necessary to reduce the amount of fluids consumed by the child during the night or in the evening. This helps to reduce the amount of urine being produced in the night, thereby helping reduce chances of bed wetting. However, this should be handled in a manner that does not appear as a punitive measure. It needs to be incorporated into the routine without causing any kind of insecure feeling in the child. The routine should also include the need to get the child use the washroom before going to bed.
Similarly waking up the child at specific times in the night, will also help in conditioning the child to consciously visit the washroom when there is an urge to urinate. This could be by using an alarm, after which the child can be taught to wake up alone without the need for an alarm.
Developing the right kind of response to stimuli – one of the common therapeutic methods used is the response to stimuli training. This involves the use of a moisture sensitive pad to trigger an alarm. Whenever the moisture level in the pad increases beyond a threshold, an alarm is triggered. This will then help the child to make it to the washroom and it will also make the child more aware of the stimuli of moisture. This treatment is ideal for the purpose of helping the child become more aware of the sensations. It is a short-term treatment option which typically does not go beyond 8 or 12 weeks.
Rewards – are another way of helping the child make more conscious efforts to stay dry throughout the night. However this needs to be handled with utmost maturity, as the child should not feel that this is a method of punishment. For instance, a simple chart can be compared to depict whenever the bed has remained dry throughout a particular period. And depending on the number of nights that the bed has remained dry, the child can be rewarded with small gifts. This will help the child to make more conscious efforts and get into a routine.
Surgical methods for treating bedwetting
Surgical methods are another option for treating bedwetting and will conclusively help deal with the condition. Nocturnal enuresis will sometimes require surgery for a clear solution. Some of the more commonly used surgical intervention methods are intended to treat conditions such as – obstructive sleep apnea, heart block and abnormalities in the urinary system including ectopic ureter. Bedwetting is attributed to some of these conditions and in certain cases surgery will be the best option to effectively deal with the condition.
Medication for treating bed wetting
In cases where bedwetting has not been corrected through a change in behaviour or routine, it may be necessary to rely on medications. Some of the commonly prescribed medications for treating nocturnal enuresis include – desmopressin acetate, oxybutynin chloride, hyoscyamine sulphate and imipramine. Antidiuretics such as desmopressin acetate helps to treat nocturnal enuresis that is primary in nature. Available as a nasal spray or in oral medication form, it is used prior to bedtime and is generally used in conjunction with alarm therapy. Similarly anticholinergic medications help to bring down the muscle contractions in the bladder. This is important as it helps to reduce the number of visits to the washroom that may be required at bedtime. This is usually taken at bedtime as an oral medication. Other medications that are used for treating the condition include oral antibiotics. These are primarily intended for treating various urinary tract infections that could be the reason behind bed wetting.
Treatment options for bedwetting in adults
Adults grappling with the problem of bedwetting may also require to undergo certain surgical procedures for treating bedwetting. This is often the last resort, after other medications and behavioral therapies have failed. Some of the commonly used treatment options for bedwetting in adults include – bladder augmentation, detrusor myectomy and sacral nerve stimulation. The first procedure, namely, bladder augmentation involves an operation that is intended to increase the size of the bladder. As a result of this surgical procedure, the volume of urine that can be retained in the bladder will increase substantially. This will prevent bed wetting as the individual will be in a position to retain more urine while asleep. The second surgical procedure, detrusor myectomy, is relatively major in nature and is intended to treat a bladder that is overactive. This procedure involves the removal of some of the muscles that are located around the bladder. The purpose of this removal is to prevent the contractions that occur during the night. Consequently bedwetting will be controlled, as the muscles do not contract involuntarily, during the night. The third procedure, sacral nerve stimulation, is a reversible process that is used for treating an overactive bladder. This involves the use of a small device that triggers impulses to a specific group of nerves. Known as sacral nerves, and located in the lower back of the body, these nerves, are responsible for various actions that control the bladder. The insertion of the device helps in controlling an overactive bladder, thereby preventing bedwetting. By virtue of being a reversible procedure, it is regarded as one among the more preferred modes of treatment.
Other remedial measures for treating bedwetting
In addition to the above medications, and surgical procedures, it is also possible to rely on simple changes in lifestyle and home remedies for treating the condition. For instance, reduction in the amount of fluid intake in the evening or late afternoon, will go a long way in reducing the amount of urine being produced later in the night. However it is important to understand that fluids are very important for overall health. Therefore, it is necessary to maintain the fluid balance and only reduce the intake during the evenings or before bedtime. A simple method to overcome this requirement is to increase the amount of fluid intake in the morning and early in the afternoons. This will help reduce the thirst later in the evenings. Similarly it is necessary to prevent consumption of beverages in the evening that have heavy caffeine content. Caffeine stimulates the bladder, and children who consume more caffeine products in the evening are likely to experience the urge for urinating later in the night. Consequently, bedwetting possibilities are higher. It is therefore necessary to ensure that food products and beverages with caffeine are not consumed in the evening. Getting into a routine is most important for children as this will help to follow healthy habits. For instance, using the washroom, before hitting the bed needs to be a part of routine. Similarly, children need to be encouraged to use the washroom whenever necessary during the day, without trying to control passing of urine. Ideally, the child needs to be taught to pass urine once in three hours throughout the day. One of the uncomfortable outcomes of bedwetting is the formation of rashes. Undergarments that are worn in the night are likely to be wet as a result of bed wetting. This can result in rashes in or around the area. It is necessary to take adequate preventive measures and ensure that rashes do not form. This could include the use of ointments and creams that it act as a barrier between the skin and moist undergarments.
Education: Doctor of Pharmacy (PharmD) from the University of Florida. Experience: 5 years as a pharmacist and medical writer, creating content on medication management and pharmaceutical news for healthcare blogs and patient education sites.
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