Bed-wetting which occurs in children above the age of five is called Enuresis or Nocturnal Enuresis. Persistence of bed-wetting after the age of 5 is around 15%; this rate decreases by 15% every year and it declines to 1-2% for an individual at the age of 15. It is usually two times more common in boys.
If genetic factors are analyzed and it is found that childhood was experienced by mother or father in childhood, the risk is 40%, while the figure increases to 70%, if the history is notable for both mother and father. Moreover, the problem disappears almost when it disappeared in mother or father. When the children with bed-wetting is brought to a physician, problems which may associate with bed-wetting, such as urinary tract infection, day time urinary problems or constipation, should be primarily investigated. Diagnosis can be mostly made, when urination and defecation habits, fluid intake, sleep patterns and psychological state of the child are carefully addressed in association with a comprehensive examination. Moreover, urinalysis and voiding test are quite beneficial in terms of diagnosis.
Underlying causes of bed-wetting include production of urine above the capacity of the urinary bladder due to insufficient secretion of the hormone vasopressin, which prevents urine production at night, overactive bladder and heavy sleep pattern which prevents waking up with the sense of voiding. Moreover, it may be secondary to certain diseases, such as diabetes mellitus and infections.
It is critical for the treatment that the child is at or above 5 years of age and willing to stay dry. Family should be informed that the problem will spontaneously improve by 15% every year. It should be remembered that psychological factors (divorce, new sibling, school problems etc.) may play a major role, especially for children who start bed-wetting after they have already gained toilet habits.
The first step of the treatment is the modification of life style. Simple applications such as modifying fluid intake and food consumption habits before going to bed at night, preventing the constipation, emptying the bladder before going to bed and waking the child for voiding after a certain period of time can ensure staying dry during night in some of the patients. Medical treatment (or alarm) under supervision of a physician should be started for children with problems that persist despite these practices.
While various methods are suggested as medical treatment, a medicine called desmopressin, which suppresses urine production at night, and an alarm system to condition the child for sensation of wetness by waking the child after bed-wetting are commonly accepted nowadays.
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