Nocturnal enuresis means bed-wetting at night. It is very common in children and is present in approximately 15 percent of children 5 and under. It generally goes away as children get older, and is only present in 1 percent of adolescents.

Causes

There are three main causes. The first is an immature bladder function. These children often have problems holding urine even in the daytime, and can wet their clothes. The second reason is increased urine production during the night, compared to during the day. Third is awakening during sleep. 

Young children are capable of waking up during the night when they feel the urge to urinate. However, children with nocturnal enuresis cannot wake up from deep sleep. The causes of nocturnal enuresis are thought to work together in a complex mechanism. Other psychological issues can contribute, such as having a younger sibling born, or having moved house recently.

Treatment

Nocturnal enuresis can regress naturally with age. However, delayed treatment can lead to decreased self-confidence and those children grow up to develop passive personalities. Therefore, it is best to treat before age 5.

Treatment options include pharmacological treatment and nocturia alarms. Pharmacological treatments can decrease the amount of urine produced at night, and can have an effectiveness of 70-80 percent. The treatment is effective within a few days.

After a few months of treatment, the medication can be weaned off of if the symptoms of nocturnal dnuresis regress. However, the recurrence rate is approximately 40-50 percent. There are minimal side effects associated with pharmacological treatment.

A nocturia alarm is a sensor on the underwear of the child, which rings when the child wets the bed. This allows the child to wake up immediately after wetting the bed, to develop an awareness of the sensation of a full bladder. With repeated practice, the child learns to wake up during the night to empty the bladder.

Children often cannot wake up even when the alarm rings, and in this case, the parents need to help the child to wake up. Nocturia alarms have an efficacy of 70-80 percent and the treatment is effective after a couple of months of use. However, the rate of recurrence is lower, at 20-30 percent, compared to pharmacological treatment. This treatment requires efforts and willingness of both the parents and the child. 

By Baek Min-ki

The author is a doctor at Department of Urology at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ― Ed.