Bedwetting (Nocturnal Enuresis)

What Is Enuresis?

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 happens at night while sleeping, after the age when a person should be able to control their bladder. (Involuntary urination that happens during the day is known as diurnal enuresis.)

Most of us think of bedwetting as something that happens with little kids. But this problem affects about 1–2 out of every 100 teens.

What Happens in Enuresis?

There are two kinds of enuresis:

• Someone with primary nocturnal enuresis has wet the bed since they were a baby. This is the most common type of enuresis.
• Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control their bladder.

The bladder is a muscular receptacle, or holding container, for pee (urine). It expands (gets bigger) as pee enters and then contracts (gets smaller) to push the pee 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. But they think that these things may play a role:

• Hormonal problems. A hormone called antidiuretic hormone, or ADH, causes the body to make less pee at night. But some people's bodies don't make enough ADH, which means their bodies may make too much pee 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 pee. Some teens and adults also have relatively small bladders that can't hold a lot of pee.
• 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.
• Caffeine. Using caffeine causes a person to pee more.
• Medical conditions. Medical conditions that can trigger secondary enuresis include diabetes, urinary tract abnormalities (problems with the structure of a person's urinary tract), constipation, and urinary tract infections (UTIs).
• Psychological problems. Some experts believe that stress can be linked to enuresis.

Doctors don't know exactly why, but more than twice as many guys as girls have enuresis. It is often 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.

The doctor will do an exam, and ask you about any concerns and symptoms you have, your past health, your family's health, any medicines you're taking, any allergies you may have, and other issues. This is called the medical history. They 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 Enuresis 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 exam do not find a 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, such as 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 foods that can irritate the bladder. These include coffee, tea, chocolate, and sodas or other carbonated beverages with 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. 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. 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 pee 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 pee until the morning.
• Sometimes doctors treat enuresis with medicine. But no medicine has been proved to cure bedwetting permanently, and the problem usually returns when the medicine is stopped. Doctors sometimes prescribe a manmade form of ADH to decrease pee buildup during the night. Other medicines relax the bladder, allowing it to hold more pee.

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 they had the problem as a teen.

The good news is that it's likely that bedwetting will go away on its own.