Bedwetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence. For infants and young children, urination is involuntary. Most children achieve some degree of bladder control by 4 years of age.Daytime control is usually achieved first, while nighttime control comes later.The child who wets the bed needs parental support and reassurance.
- Primary bedwetting: refers to bedwetting that has been ongoing since early childhood without a break.It probably indicates immaturity of the nervous system.
- Secondary bedwetting: is bedwetting that starts again after the child has been dry at night for a significant period of time.It can be a sign of an underlying medical or emotional problem.
The information provided by the parents, classroom teacher and school counselor about the child’s academic difficulties guides the pediatrician to form an initial diagnosis.The evaluation of academic underachievement needs to be comprehensive and address multiple areas of function. Ultimately, the history must address 3 questions:
- The child cannot yet hold urine for the entire night.
- The child does not waken when his or her bladder is full.
- The child produces a large amount of urine during the evening and night hours.
- The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can.
- Urinary tract infection: The resulting bladder irritation can cause lower abdominal pain or irritation with urination (dysuria), a stronger urge to urinate (urgency), and frequent urination (frequency).
- Diabetes: People with type I diabetes have a high level of sugar (glucose) in their blood. The body increases urine output as a consequence of excessive blood glucose levels.
- Structural or anatomical abnormality: An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence or other urinary problems that could show up as bedwetting.
- Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.
- Sleep patterns: Obstructive sleep apnea (characterized by excessively loud snoring and/or choking while asleep) can be associated with enuresis.
- Excessive fluid intake: Drinking too much water before 1-2 hours of sleep.
