NOCTURNAL ENURESIS (AKA BEDWETTING)

14 Feb

BY DR DORTE BLADT

As a kids chiropractor, I often care for children who wet the bed at night.

Bedwetting can be an embarrassing and emotionally upsetting experience for a child, even though it is actually very common. In fact, according to the Royal Children’s Hospital in Melbourne, 30% of 4-year-olds wet the bed.

At this age it is considered normal.

However, a diagnosis of “nocturnal enuresis” is given if it affects a child over 5 years old – 15% of 5-year-olds wet the bed, 5% of 10 year olds wet the bed, and 2% of 15 year olds wet the bed.

These statistics are surprisingly similar all over the world:

Nocturnal enuresis affects twice as many boys as girls
20% of kids with nocturnal enuresis also have daytime accidents and 15% have bowel accidents
75% of children whose parents both wet the bed suffer with enuresis and 50% if only one parent did

There are theories abound for the cause of enuresis. In this blog, we explore the theories behind bedwetting so you can better understand the issue, plus we share some exercises, treatments and medications that can potentially help minimise bed wetting and achieve a dry night!

Theories about bedwetting and nocturnal enuresis

If your child has never been dry at night, he will have what is called primary enuresis, whereas secondary enuresis means the child has had at least 6 months of being dry at night.

Secondary enuresis can be caused by psychological stress such as a new baby in the family, changing schools, moving house or similar. It can also be related to a urinary tract infection or constipation, diabetes, sleep apnea or obesity.

Primary enuresis is thought to be caused by having a smaller bladder, producing more urine at night, bladder muscle (detrusor) overactivity, poor sleep pattern, global maturation delays and poor brain bladder connection. Research has shown that children with ADHD also have a higher incidence of bedwetting.

“Remember - a child will never wet the bed to be naughty and being upset with your child will only make matters worse.”

Enuresis & constipation

Constipation is an important factor in enuresis.

A child over five-years-old will usually take care of toileting himself and may not be aware of what is a normal bowel movement and what’s not.

Constipation may cause “overflow” movements, resulting in “loose” stool – fecal material which has squeezed around compacted feces. This may cause “skiddies” or accidents which causes the child to think he has had a bowel movement.

Keeping a food diary will be helpful to monitor the amount of fibre and fluids consumed and may also highlight possible food intolerances. Lack of physical activity can be involved in constipation and potentially irritate the bladder.

Exercises & activities to help minimise bedwetting

Some common exercises to help children who wet the bed include sticker charts and prizes for having a dry night, or there’s also “lifting” i.e. waking your child in the middle of the night to go to the bathroom.

According to one study, parents practiced “lifting” over a six month period – more than 37% of children in the study had improved symptoms, whereas offering a positive reward for having a dry night did nothing.

In the same vein as “lifting”, bedwetting alarms are a popular approach. According to Doctor Glazener from the University of Aberdeen, Scotland, almost half of the children in his bedwetting study stayed dry overnight with a bedwetting alarm.

Common medications prescribed for bedwetting and nocturnal enuresis

An increasingly common medical treatment is the prescription of Desmopressin, a synthetic antidiuretic hormone which mimics the effect of vasopressin – a natural hormone which normally increases at night to decrease urinary output from the kidneys.

According to literature around Desmopressin, it fixes bedwetting completely in 30% of kids with another 40% experiencing improvement. However, there is a 70% recurrence once medication is stopped.

Some methods to avoid

Some parents are vigilant when it comes to decreasing fluid intake later in the day.

Although it makes sense to decrease drinking for an hour or so prior to bedtime, limiting fluids can increase the concentration of the urine, irritating the bladder lining and exacerbating the poor bladder control at night.

It’s also important to be aware that coffee, tea and soft drinks are diuretics, meaning they increase urinary output.

Unfortunately, research has shown that pelvic floor exercises are not effective as a treatment for nocturnal enuresis, either. Overall muscle tone is, though, as it stimulates brain function and brain-body connection, so you should encourage your child to keep physically active in sport and play.

Some final notes from your local children’s chiropractor

In my experience, “stressing” the bladder can be a good way to connect the brain and the bladder. I would suggest that the whole family participates, so as not to single anyone out.

At a convenient time, drink a huge amount of water and then try not to go to the bathroom. Hang on, hang on, curl the toes, squeeze the knees… Only go to the bathroom when it is impossible to hang on anymore!

This will help stretch the detrusor muscle and “wake up” the sensory nerves to sensitise the brain to the sensation of a full bladder.

Jumping and running with a full bladder will have a similar effect!

Hopefully, this has given you some ideas to help your child overcome this “inconvenience”.

If you have any questions about nocturnal enuresis or bed wetting, please feel free to ask The Family Chiro team – we’re always here to help!

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