What Is Enuresis?

Alex falls into an extremely deep sleep almost every night. He sleeps so soundly that you could set off a fire alarm next to his bed and he probably wouldn't hear it. Even having to pee doesn't wake him up, so Alex sometimes wets the bed. He feels embarrassed, but isn't alone — this problem affects about 1-2 out of every 100 teens.

The medical name for not being able to control your pee is enuresis (pronounced: en-yuh-ree-sis). Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that occurs at night. (Involuntary urination that happens during the day is known as diurnal enuresis.)

There are two kinds of enuresis: primary and secondary. Someone with primary nocturnal enuresis has wet the bed since he or she was a baby. Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control his or her bladder.

The bladder is a muscular receptacle, or holding container, for pee (urine). It expands (gets bigger) as urine enters and then contracts (gets smaller) to push the urine out.

In a person with normal bladder control, nerves in the bladder wall send a message to the brain when the bladder is full; the brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom. But people with nocturnal enuresis have a problem that causes them to pee involuntarily at night.

What Causes Enuresis?

Doctors don't always know the exact cause of nocturnal enuresis. They do have some theories, though, on what may contribute to someone developing the condition:

• Hormonal problems. A hormone called antidiuretic hormone, or ADH, causes the body to produce less urine at night. But some people's bodies don't make enough ADH, which means their bodies may produce too much urine while they're sleeping.
• Bladder problems. In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine. Some teens and adults also have relatively small bladders that can't hold a large volume of urine.
• Genetics. Teens with enuresis often have a parent who had the same problem at about the same age. Scientists have identified specific genes that cause enuresis.
• Sleep problems. Some teens may sleep so deeply that they don't wake up when they need to pee
• Medical conditions. Medical conditions that can trigger secondary enuresis include diabetes, constipation, and urinary tract infections. Spinal cord trauma, such as severe stretching of the spinal cord resulting from a fall, sports injury, auto accident, or other event may also play a role in enuresis, although this is rare.
• Psychological problems. Some experts believe that stress can be associated with enuresis. It's not uncommon to feel stressed out during the teenage years, and things such as divorce, the death of a friend or family member, a move to a new town and adapting to a new school and social environment, or family tension can all feel overwhelming.

Doctors don't know exactly why, but more than twice as many guys as girls have enuresis. It is frequently seen in combination with ADHD.

How Is Enuresis Diagnosed?

If you're having trouble controlling your urine at night, talk to your doctor to learn more about nocturnal enuresis and to rule out the possibility of a medical problem.

In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history. He or she may ask about sleep patterns, bowel habits, and urinary symptoms (such as an urge to pee a lot or pain or burning when you pee). Your doctor may also discuss any stressful situations that could be contributing to the problem.

The initial exam will probably include a urinalysis and urine culture. In these tests, urine is examined for signs of disease. Most of the time in people with nocturnal enuresis, these test results come back completely normal.

How Is It Treated?

Doctors can do several things to treat bedwetting, depending on what's causing it. If an illness is responsible, which is not very common, it will be treated. If the history and physical examination do not suggest a specific medical problem and the urine tests are negative, several behavioral approaches can be used for treatment:

• Manage what you eat and drink before bed. People with nocturnal enuresis can take some basic steps to prevent an overly full bladder by decreasing the amount of fluids they drink before going to bed. You can reduce the chances that you'll wet the bed by going to the toilet just before bedtime.
  
  It may help to avoid eating certain foods in the evening: Foods that can irritate the bladder include coffee, tea, chocolate, and sodas or other carbonated beverages containing caffeine.
• Imagine yourself dry. Using a technique called positive imagery, where you think about waking up dry before you go to sleep, can help some people stop bedwetting. Some people find that rewarding themselves for waking up dry also works.
• Use bedwetting alarms. Doctors and nurses sometimes prescribe bedwetting alarms to treat teens with enuresis. According to the National Kidney Foundation, 50% to 70% of cases of enuresis respond to treatment with these moisture alarms. With these alarms, a bell or buzzer goes off when a person begins to wet the bed. Then, you can quickly turn the alarm off, go to the toilet, and go back to sleep without wetting the bed too much. Don't get discouraged if the alarm doesn't help you stop wetting the bed immediately, though. It can take many weeks for the body to unlearn something it's been doing for years. Eventually, you can train yourself to get up before the alarm goes off or to hold your urine until morning.
  
  People who sleep very deeply may need to rely on a parent or other family member to wake them up if they don't hear the alarm. The key to bedwetting alarms is waking up quickly — the sooner a person wakes up, the more effective the behavior modification for telling the brain to wake up or send the bladder signals to hold the urine until the morning.
• Sometimes doctors treat enuresis with medication — although this is not usually the first course of action because no medication has been proved to cure bedwetting permanently, and the problem usually returns when the medication is stopped. Doctors sometimes prescribe a manmade form of ADH to decrease urine buildup during the night. Other medications relax the bladder, allowing it to hold more urine.

If you're worried about enuresis, the best thing to do is talk to your doctor for ideas on how to cope with it. Your mom or dad can also give you tips on how to cope, especially if he or she had the problem during adolescence.

The good news is that it's likely that bedwetting will go away on its own. In fact, 15 out of 100 kids who wet the bed will stop every year without any treatment at all.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2012
Originally reviewed by: Robert Walter, MD