Materiały źródłowe

• #1 Enuresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545181/

  Enuresis, commonly known as bedwetting, is a prevalent pediatric condition affecting approximately 15% of 5-year-old children. The condition is characterized by involuntary urination during sleep at least twice a week for 3 months in children older than 5. Enuresis is classified into 2 primary types: monosymptomatic enuresis, where bedwetting is the sole symptom, and non-monosymptomatic enuresis, which includes additional urinary symptoms such as urgency or frequency. […] This condition can lead to significant emotional distress, social isolation, and academic difficulties, particularly if not managed sensitively and effectively. […] The etiology of enuresis is multifactorial, with a solid genetic component influenced by physiologic and environmental factors. Children with 1 affected parent face a 44% likelihood of developing enuresis, and those with 2 affected parents have a 77% likelihood. […] The following list includes the potential causes of both primary and secondary enuresis: […] Children with NMNE typically have anatomic causes, including structural urinary tract abnormalities leading to impaired bladder function.

• #1 Bed-Wetting: Approaches to Nocturnal Enuresis in Children

  https://www.uspharmacist.com/article/bedwetting-approaches-to-nocturnal-enuresis-in-children

  A child with primary nocturnal enuresis has never achieved a satisfactory period of nighttime dryness; this classification accounts for about 80% of patients. […] Secondary nocturnal enuresis, the development of enuresis after a dry period of at least 6 months, is typically seen in children who are going through a remarkably stressful experience, such as a shift in family dynamics (e.g., divorce, birth of a sibling), and accounts for 20% of cases. […] Nocturnal enuresis may result from one or a combination of several possible factors. The major mechanisms include nocturnal polyuria, detrusor overactivity, and disturbed sleep. […] Regulatory hormones, specifically antidiuretic hormone (ADH), play an essential role in urine output and are secreted at night, following circadian rhythm. A nighttime rise in ADH would signal the body to create less urine. It is postulated that children with nocturnal enuresis have not developed this circadian rhythm, and as a result have nocturnal polyuria.

• #1 Enuresis in Children: Common Questions and Answers | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html

  Secondary monosymptomatic nocturnal enuresis is more likely to have an underlying pathologic cause and may be the first sign of a new medical issue. […] Nonmonosymptomatic nocturnal enuresis occurs in 15% to 30% of children with enuresis. […] Diagnosis and treatment of the underlying pathology causing the daytime symptoms should occur before nocturnal enuresis therapy. […] When first-line therapies fail to achieve dry nights, reevaluate and address secondary causes (e.g., constipation, behavioral issues, sleep-disordered breathing). […] Additional medications useful in treating monosymptomatic enuresis include imipramine and oxybutynin.

• #1 Case Based Pediatrics Chapter

  https://www.hawaii.edu/medicine/pediatrics/pedtext/s13c09.html

  Interestingly, family studies show a strong genetic predisposition for enuresis. […] Organic causes of bedwetting account for a small minority of cases, mostly due to urinary tract infections. […] The office evaluation of nocturnal enuresis must exclude any organic causes. […] Because most cases of primary enuresis are monosymptomatic, the physical examination will typically be normal. […] The purpose of initial laboratory tests is to rule out infectious and metabolic etiologies. […] At present, no treatment modality is 100% successful. […] Behavioral therapy with an auditory or vibratory alarm is most effective in the treatment of nocturnal enuresis. […] The other established first-line therapy for nocturnal enuresis is desmopressin (DDAVP), a synthetic analog of vasopressin. […] Additional pharmacologic options exist for children with enuresis that is resistant to alarms and desmopressin. […] Imipramine, a tricyclic antidepressant, has also been FDA-approved for the treatment of nocturnal enuresis and is considered third line.

• #1 Nocturnal enuresis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348193/

  Nighttime incontinence, otherwise known as nocturnal enuresis, is a common condition that can cause substantial psychological distress in children with the condition. Nocturnal enuresis is defined as nighttime bedwetting in children five years of age or older. […] Although very little progress has been made recently in the treatment of bedwetting, there is a greater understanding of the pathophysiology of this condition, in particular, the role of the central nervous system. Here we discuss the proposed pathophysiology behind bedwetting, investigations and evidence for current treatments. […] There are three commonly proposed mechanisms to bedwetting. These include excessive nocturnal urine production, bladder overactivity and a failure to awaken in response to bladder sensations. Each mechanism can be supported by various studies, and no one theory is likely to explain bedwetting in all children. Excessive nocturnal urine production in some children is based on abnormal nocturnal plasma vasopressin release. […] Newer theories point to the role of the central nervous system in bedwetting. Parents of children who wet the bed often claim that they are deep sleepers. Children with nocturnal enuresis may, however, have sleep disruption.

• #1 Enuresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545181/

  To understand the pathophysiology of enuresis, clinicians must first understand normal bladder maturation. At birth, voiding is uncontrolled. […] The majority of children with MNE will have spontaneous resolution of their symptoms, indicating a delay in normal bladder maturation. […] Children with nocturnal enuresis have increased nighttime urine output when compared to their peers without enuresis. […] The contribution of disturbed and excessively deep sleep to enuresis must be clarified. […] Children with enuresis have a higher arousal threshold during sleep and difficulty awakening. […] Enuresis often improves or resolves after tonsillectomy and adenoidectomy in these patients. […]

• #1 Bed-Wetting | Fact Sheet – ABCT – Association for Behavioral and Cognitive Therapies

  https://www.abct.org/fact-sheets/bed-wetting/

  About 15% of all elementary-school-age children wet the bed, and continued bed-wetting beyond the age of 5 is a problem that should be treated. […] Health care professionals refer to any accidental or uncontrolled wetting as enuresis. […] Bed-wetting runs in families and may be partly hereditary. […] The idea that bed-wetting will simply go away if you are just patient and wait long enough is misleading. […] Enuretic children often have smaller functional bladder capacities. […] Some evidence suggests that at least some bed-wetting children also produce less anti-diuretic hormone during sleep. […] Many people believe that children wet the bed because they are deep sleepers. This theory is not supported by research. […] Food allergies are rarely related to bed-wetting. […] Bed-wetting is distressing to children and parents.

• #1 The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study | Scientific Reports

  https://www.nature.com/articles/s41598-021-96519-w

  Primary nocturnal enuresis (PNE) affects childrens physical and mental health with a high rate. […] Up to now, the pathogenesis of PNE is still unknown, but most of the specialists believe it may be related to awakening dysfunction, insufficient secretion of antidiuretic hormone, unstable contraction of detrusor and other factors, among which awakening dysfunction is the prerequisite. […] Therefore, understanding the neural mechanism of awakening dysfunction is very important for the diagnosis and treatment of PNE. […] This study showed how sleep/wakefulness could occur through a coordinated shift in thalamic activity. […] Activation of PVT-NAc pathway can induce the transition from sleep to wakefulness. […] In this study, there was a statistical significant difference of the comparison of the FC of the lPVT and the lNAc between PNE and TD children while other five FCs had no statistical significant difference.

• #1 Bedwetting (Nocturnal Enuresis) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/bedwetting-nocturnal-enuresis

  Nocturnal enuresis, better known as nighttime bedwetting, occurs when a child who is toilet trained cannot hold their urine during sleep, typically wetting their bed once or twice a night. […] Although bedwetting sometimes occurs if your child is feeling emotional stress or insecurity, it isn’t usually a behavioral issue. Instead, there is more evidence suggesting that enuresis is the result of a developmental delay in the normal process of achieving nighttime control. The normal process involves the release of a hormone that prompts the kidneys to slow down production of urine during nighttime sleep. This hormone, called vasopressin, is not secreted enough in many children who have a problem at night. […] If your child is embarrassed to attend camp or a sleepover, you may want to talk with your pediatric urologist about some of the following therapies: Drug therapy that includes DDAVP, which replaces the natural hormone vasopressin.

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Sleep studies reveal that children with enuresis do not wake up normally in response to an auditory signal; this finding confirms a problem in arousal. […] Studies reveal nocturnal polyuria in some but not all children with enuresis. Although nocturnal polyuria is important in the pathophysiology of enuresis, overproduction of urine per se cannot be the sole causal factor. […] Small functional bladder capacity (FBC) is now known to play a role in the pathogenesis of enuresis. […] Overactive bladder or dysfunctional voiding is more common among girls in preschool or elementary school, usually presenting with urinary frequency, urgency, squatting behavior, daytime wetting, and enuresis. […] Cystitis is a common cause of enuresis and an aggravating factor associated with other causes; cystitis associated with enuresis may present at any age.

• #1 Enuresis (Bed Wetting) in Children: Common Causes and Reasons

  https://www.houstonent.com/blog/enuresis-bed-wetting-in-children-common-causes-and-reasons

  Enuresis is the term giving to older children (over five years old) who wet their bed during the night while they are asleep. […] However, up to 80 percent of children with enuresis have concurrent obstructive sleep apnea (OSA), making it one of the top signs and symptoms of sleep apnea in children. […] Bedwetting is a common symptom in kids with sleep apnea. […] When your child has untreated sleep apnea, its difficult for them to breathe properly at night. This makes their brain have to work harder to draw in oxygen causing it slack off on controlling other bodily functions, such as controlling their bladder. […] The study concluded that in kids with suspected sleep-disordered breathing, there’s a high prevalence of enuresis. This could be due to obstructive sleep apnea effects on bladder pressure, arousal response and urinary hormone secretion.

• #1 Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association?

  https://smw.ch/index.php/smw/article/download/2270/3420?inline=1

  Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or family practitioner; if there is any doubt, the children may be referred to a paediatric urologist. […] Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. […] The presence of both upper airway narrowing and nocturnal enuresis exhibited the highest sensitivity for detecting children with OSAS.

• #1 Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association?

  https://smw.ch/index.php/smw/article/download/2270/3420?inline=1

  Nocturnal enuresis has been significantly associated with the presence of moderate-to-severe OSAS in a fully adjusted model considering tonsillar hypertrophy, obesity, gender and age. […] Increased intra-abdominal pressure caused by respiratory efforts against an obstructed airway has been implicated in the pathogenesis of nocturnal enuresis because of increasing bladder pressure. […] Urinary excretion of sodium and diastolic blood pressure have been found to increase in parallel with the severity of obstructive SDB. […] SDB can affect the secretion of urinary hormones such as atrial natriuretic peptide (ANP) and ADH. Nocturnal increase in ANP and a decrease in ADH are responsible for the nocturnal diuresis and natriuresis associated with OSA. […] Nocturnal enuresis may eventually be triggered by sleep apnoea because an accentuated negative intrathoracic pressure during sleep leads to abnormal secretion of ANP. […] Treatment of obstructive SDB, mainly due to tonsil and adenoid hypertrophy, leads to significant resolution of nocturnal enuresis in most patients, accompanied by normalisation of ADH, ANP and BNP levels, and concomitant improvement of HRQoL.

• #1 Bedwetting in Children & Teens: Nocturnal Enuresis | National Kidney Foundation

  https://www.kidney.org/kidney-topics/bedwetting-children-teens-nocturnal-enuresis

  Nocturnal enuresis means wetting the bed at night. It usually happens after age 5, and it affects many school-age children and even some teens. It’s not a serious health problem, and children usually outgrow it. Still, bedwetting can be upsetting for children and parents. […] Bedwetting in this age group could be a sign of a urinary tract infection or other health problems, neurological issues (related to the brain), stress, or other issues. […] Its not completely known why bedwetting occurs, but its thought to happen because of a delay in the development of one or more these areas of the body that cause problems at night: The kidneys make more urine at night. Theres less space in the bladder to hold urine at night. The brain cant wake the body up during sleep. […] A bowel that is stuck with stool (constipation) can push on the bladder and cause the child to lose bladder control. Treating the constipation is often the first step to treating the bedwetting in these cases.

• #1 Understanding Bedwetting in Kids | Lurie Children’s

  https://www.luriechildrens.org/en/blog/bedwetting-in-kids/

  Bedwetting may also run in families, according to Ravoori. Kids who wet the bed may have parents who experienced bedwetting at about the same age. […] Constipation plays a role in bedwetting for some kids. This is because the end of the colon primarily the rectum sits against the bladder. […] The relationship is so strong that when healthcare providers treat constipation, about half of kids stop wetting the bed, Ravoori says. […] About one in five kids who wet the bed has a health condition that affects their ability to hold urine through the night, according to Ravoori. […] If your child has certain symptoms, your provider may recommend a urine test: Providers check a sample of your child’s urine for blood or protein. […] If your child has an underlying medical condition, providers treat the condition first. This treatment may stop your child from wetting the bed.

• #1 Pediatric Incontinence (Enuresis) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bedwetting

  A number of issues can be involved in a childs bedwetting and daytime accidents, including: […] Because the nerves from rectum and the bladder are in close proximity to each other in the spine, there is a mixing of signals that can trigger bladder contractions and lead to urinary incontinence. […] Sometimes premature potty-training will lead children to push to urinate (urine should be released without being forced). When this happens, the pelvic floor muscles dont relax and eventually the child can develop problems with urination. […] The childs bladder may involuntarily contract and release urine before its full. […] When a child doesnt wake up from sleep to urinate, bedwetting can become a problem. […] If you had this issue growing up, your children are more likely to as well.

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  The International Childrens Continence Society (ICCS) restricts the term enuresis to wetting that occurs at night. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. It is felt that the pathogenesis of PE is similar to that of SE. […] In PE, psychological problems are almost always the result of the condition and only rarely the cause. In SE, however, psychological problems are a possible cause, albeit not a common one. The comorbidity of behavioral problems is two to four times higher in children with enuresis. […] If no cause can be identified, the important pathophysiologic factors include a disorder of sleep arousal, nocturnal polyuria, and a low nocturnal bladder capacity.

• #1 Urine metabolic phenotyping in children with nocturnal enuresis and comorbid neurobehavioral disorders | Scientific Reports

  https://www.nature.com/articles/s41598-021-96104-1

  The prevalence estimates of enuresis in children with ADHD have been reported in 22-32%. […] The KEGG pathway analysis revealed the changes of urinary betaine, creatine and guanidinoacetate concentrations involved in glycine, serine and threonine metabolism appeared to have statistically significant relations to a comorbidity of ADHD or anxiety in persistent bedwetting children. […] Our results provided metabolomics insights into pathophysiological of childhood NE and its association with neurobehavioral disorders such as ADHD. […] We also suggested the likelihood of betaine in modulation of renal and central circadian clock systems in children with both NE and ADHD.

• #1 Child Bedwetting: Causes of Primary and Secondary Bedwetting

  https://www.webmd.com/sleep-disorders/bedwetting-causes

  Secondary bedwetting can be a sign of an underlying medical or emotional problem. […] Common causes of secondary bedwetting include the following: Urinary tract infection. The resulting bladder irritation can cause pain or irritation with peeing, a stronger urge to pee (urgency), and frequent peeing (frequency). […] Sleep apnea. When your child’s breathing is disrupted, their brain works harder to take in oxygen than it does on other functions, like bladder control. […] Neurological problems. Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls peeing. […] Bedwetting is quite common in children who have attention deficit hyperactivity disorder (ADHD). Kids with ADHD are three times as likely to have trouble with bedwetting than those who don’t.

• #1 Child Bedwetting: Causes of Primary and Secondary Bedwetting

  https://www.webmd.com/sleep-disorders/bedwetting-causes

  Experts aren’t sure why ADHD is linked to bedwetting. But some people think it’s because both things are related to a delay in the development of someone’s central nervous system. […] If your child has autism spectrum disorder (ASD), they might also be more likely to wet the bed. But experts still need to do more research to discover why ASD is linked to bedwetting. […] Bedwetting does tend to run in families. Many children who wet the bed have a parent who did too. […] About 40% of 3-year-olds wet the bed. […] Sometimes a child’s bladder is simply not developed enough to store pee for an entire night. […] Most children of school age who wet the bed at night have what doctors call „primary enuresis.” They have never had nighttime control of their bladder. […] If your child has been dry and then starts to wet the bed, tell your pediatrician right away.

• #1 Bed-Wetting: Approaches to Nocturnal Enuresis in Children

  https://www.uspharmacist.com/article/bedwetting-approaches-to-nocturnal-enuresis-in-children

  Bed-wetting may be associated with neuropsychiatric problems like intellectual disabilities, low self-esteem, and attention-deficit/hyperactivity disorder (ADHD). […] The development of bladder control appears to follow a progressive timeline. A child first becomes aware of bladder filling; develops the ability to suppress detrusor contractions voluntarily; and, finally, learns to coordinate sphincter and detrusor function. The child usually achieves these skills by approximately 4 years of age, at least for daytime control. Nighttime bladder control is achieved much later than daytime regulation and is not expected until age 5 to 7 years.

• #1 Case Based Pediatrics Chapter

  https://www.hawaii.edu/medicine/pediatrics/pedtext/s13c09.html

  Enuresis, commonly known as bedwetting, is one of the most common childhood urologic complaints encountered by pediatricians. Nocturnal enuresis (NE) refers to the involuntary passage of urine during sleep in a child at least 5 years of age. […] The pathogenesis of primary enuresis is multifactorial. Several important contributing factors include delayed maturation of voluntary cortical control of the micturition reflex, reduced nighttime antidiuretic hormone production, decreased bladder capacity, and impaired sleep arousal. […] Epidemiologic studies have shown that approximately 15% of enuresis cases resolve spontaneously each year, supporting delayed neurodevelopmental maturation as the main etiology. […] Decreased functional bladder capacity has also been shown in those with nocturnal enuresis as compared to normal peers.

• #1 Nocturnal Enuresis: A Novel Concept on its Pathogenesis and Treatment

  https://www.contemporaryobgyn.net/view/nocturnal-enuresis-novel-concept-its-pathogenesis-and-treatment

  At birth the parasympathetic system is the dominant division of the autonomic nervous system. As one grows up, repeated everyday life stresses increase the sympathetic tone, which gradually takes the upper hand. This explains the reports of an annual spontaneous cure rate of about 15% in those suffering nocturnal enuresis. […] However nocturnal enuresis may persist into adolescence and adult life.

• #1 Nocturnal Enuresis: A Novel Concept on its Pathogenesis and Treatment

  https://www.contemporaryobgyn.net/view/nocturnal-enuresis-novel-concept-its-pathogenesis-and-treatment

  Failure to gain the acquired high alpha-sympathetic tone (T10-L2) will leave micturition as a spinal cord reflex, as in early infancy and the full bladder will empty spontaneously. […] More frequently there is a partial gain of alpha-sympathetic tone, which will be sufficient for good control and urinary continence during the daytime but it will fail during sleep. […] The treatment, therefore, will be giving alpha-sympathomemitics and not anti-cholenergics. […] Giving an alpha-sympathomemitic drug e.g., ephedrine hydrochloride, this will increase the tone of the internal urethral sphincter, thereby preventing uncontrolled urination. […] It is the second action, (stimulating the alpha-sympathetic nerve endings to produce nor-epinephrine), that cause complete cure after giving the drug for a period that varies from two to twelve weeks according to the age of the patient and the severity of the condition.

• #1 Bed-wetting – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685

  Bed-wetting also called nighttime incontinence or nocturnal enuresis means passing urine without intending to while asleep. This happens after the age at which staying dry at night can be reasonably expected. […] It’s not known for sure what causes bed-wetting. Several issues may play a role, such as: A small bladder. Your child’s bladder may not be developed enough to hold all the urine made during the night. No awareness of a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child. This may be especially true if your child is a deep sleeper. A hormone imbalance. During childhood, some kids do not produce enough anti-diuretic hormone, also called ADH. ADH slows down how much urine is made during the night. Urinary tract infection. Also called a UTI, this infection can make it hard for your child to control the urge to pass urine. Symptoms may include bed-wetting, daytime accidents, passing urine often, red or pink urine, and pain when passing urine. Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea. Sleep apnea is when a child’s breathing is interrupted during sleep. This is often due to swollen and irritated or enlarged tonsils or adenoids. Other symptoms may include snoring and being sleepy during the day. Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of diabetes. Other symptoms may include passing large amounts of urine at once, increased thirst, extreme tiredness and weight loss in spite of a good appetite. Ongoing constipation. A child who is constipated does not have bowel movements often enough, and the stools may be hard and dry. When constipation is long term, the muscles involved in passing urine and stools may not work well. This can be linked to bed-wetting. A problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a difference in the structure of the urinary tract or nervous system.

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Various common situations predispose to a psychological cause of enuresis, including birth of a new sibling, parental divorce or separation, death in the family, child abuse, or any other cause of social dysfunction at home or school. […] Constipation can cause both PE and SE and is a common aggravating factor that should be considered when other causes are present. […] Sleep-disordered breathing (SDB) is a disorder associated with both an abnormality in arousal and enuresis. […] A neurogenic bladder can result from a lesion at any level in the nervous system, including the cerebral cortex, the spinal cord, and the peripheral nerves. […] Urethral obstruction can be congenital (as with posterior urethral valves (PUVs), congenital stricture, or urethral diverticula) or acquired (as with a traumatic or infectious stricture or with meatal stenosis after circumcision).

• #1 Enuresis in Children: A Case-Based Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1015/p560.html

  The physical examination should focus on identifying causes of secondary (nonmonosymptomatic) enuresis because findings are typically normal in primary enuresis. […] A diagnostic and therapeutic approach to enuresis in children is provided in Figure 1. […] For monosymptomatic enuresis, urinalysis is sufficient for an initial laboratory evaluation. […] Further diagnostic studies may be indicated for select patients when signs and symptoms suggest nonmonosymptomatic enuresis or an underlying medical condition. […] Combination therapy should be considered in the event of treatment failure. […] Referral to a pediatric urologist is indicated for children with primary monosymptomatic or nonmonosymptomatic enuresis whose symptoms do not improve with standard therapies or who have evidence of urinary tract malformations or recurrent urinary tract infections.

• #1 Nocturnal enuresis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348193/

  Sleep disruption may result in a loss of the physiologic inhibitory signals to the bladder seen in animal studies. […] The bed alarm is believed to address the difficulty children may have in waking in response to bladder sensations; however, many children who are successful using the alarm may remain dry without waking. Desmopressin (synthetic vasopressin) acts on the renal collecting duct and distal tubules to enhance reabsorption of water. This treatment addresses excessive nocturnal urine production, which is likely to be the cause in only a subset of children who wet the bed. […] Tricyclic antidepressants are thought to act via the brainstem through their noradrenergic action. […] Alternative therapies that have been tried for bedwetting include hypnotherapy, acupuncture, chiropractic treatment and psychotherapy. To date, there is very weak evidence to support any of these for the successful treatment of bedwetting.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx

  Research shows that about half of children who properly use enuretic (bedwetting) alarms will stay dry at night after a few weeks. […] There are only two medications that have been approved for bedwetting: imipramine and desmopressin. […] It is important to note that bedwetting usually returns once medications are stopped, unless the child has „grown out of” nocturnal enuresis. […] Imipramine works well in some children with nocturnal enuresis. […] Desmopressin (DDAVP) helps to reduce the amount of urine your body makes. […] Bedwetting almost always goes away on its own. Most children will grow out of it by the late teenage years or sooner. […] Secondary enuresis may go away when the cause is found.

• #1 Bedwetting (Nocturnal Enuresis) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/bedwetting-nocturnal-enuresis

  Nocturnal enuresis is wetting while asleep in children 5 years of age and older. A child with nocturnal enuresis wets only during sleep and urinates normally when awake. […] There are several factors that can lead to bedwetting including: Bedwetting can be hereditary. If there is a family history of parents, siblings, or other close relatives with nocturnal enuresis, it is more likely that your child will inherit the condition. […] Most children with nocturnal enuresis are very heavy sleepers. These children don’t wake up when their bladder is full. […] During sleep a hormone (vasopresson) is released in the body; it reduces urine production. When the body starts to produce vasopresson is variable, but it usually happens in early childhood. If your child’s body is not yet producing vasopresson, he may make more urine than the bladder can hold. […] It takes time for the bladder to mature and stay relaxed while your child sleeps. […] Desmopressin (DDAVP®) concentrates urine so that your child makes less urine at night and does not completely fill the bladder. DDAVP® is effective in about 50 percent of patients.

• #1 Nocturnal Enuresis (‘bedwetting’) in children | CUH

  https://www.cuh.nhs.uk/patient-information/nocturnal-enuresis-bedwetting-in-children/

  Anticholinergic medications relax the detrusor muscle that surrounds the bladder and can decrease involuntary bladder contractions and so help to enable the bladder to relax and hold more urine. […] Imipramine is a medication which is used to treat a variety of conditions. In children with bed wetting it may be a treatment option when other treatments have not been effective.

• #1 Nocturnal Enuresis – UCI Pediatric Urology

  https://ucipediatricurology.com/specialties/nocturnal-enuresis/

  Other management options include: […] The bed wetting alarm. This is a type of conditioning therapy to help your child identify the need to wake up and use the bathroom. The type of alarm should have both a vibrating mechanism and an auditory alarm to help wake the child. Proper use of this requires consistency and patience. This should be used nightly with maximization of daytime bladder and stooling habits. This may take a few months to see progress, but it is estimated 60-70 percent of children will see improvement when properly used. […] DDAVP (desmopressin): This drug decreases the amount of urine output at night. If this is effective in the patient, it is only used for special occasions such as sleep overs or overnight camps. Only 50% of patients will even respond to DDAVP. The medication should be taken two hours prior to sleep and to fluid restrict with use of medication. The side effects of hyponatremia and possible seizures were discussed. […] Imipramine (tricyclic antidepressant): Imipramine works by several means as a bladder relaxant, increases external sphincter tone, and may work via unknown CNS mechanisms. Cardiac toxicity with large amounts of imipramine have been reported. This drug is not commonly prescribed for nocturnal enuresis. […] Ditropan (anti-muscarinic): The use of ditropan is typically best for patients with daytime symptoms as well, but can occasionally help with nightime-only wetting, particularly if a small bladder.

• #1 Urine metabolic phenotyping in children with nocturnal enuresis and comorbid neurobehavioral disorders | Scientific Reports

  https://www.nature.com/articles/s41598-021-96104-1

  Nocturnal enuresis (NE) is a common problem among 10% school-aged children. The etiologies underlying childhood NE is complex and not fully understood nowadays. […] Until the present, the exact pathophysiology of childhood NE remains unclarified and is likely to be multifactorial, involving biological, developmental, genetic, psychosocial, and environmental aspects. Theoretically, nocturnal polyuria caused by vasopressin deficiency, detrusor overactivity and high arousal thresholds have been regarded as the three major pathogenetic mechanisms for MNE. […] This reflects beyond the three-system model, there are other factors involved in enuresis pathogenesis. […] Nevertheless, numerous clinical studies and population-based studies have uncovered the strong association between enuresis and attention deficit hyperactivity disorder (ADHD).

• #2 Nocturnal enuresis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348193/

  Nighttime incontinence, otherwise known as nocturnal enuresis, is a common condition that can cause substantial psychological distress in children with the condition. Nocturnal enuresis is defined as nighttime bedwetting in children five years of age or older. […] Although very little progress has been made recently in the treatment of bedwetting, there is a greater understanding of the pathophysiology of this condition, in particular, the role of the central nervous system. Here we discuss the proposed pathophysiology behind bedwetting, investigations and evidence for current treatments. […] There are three commonly proposed mechanisms to bedwetting. These include excessive nocturnal urine production, bladder overactivity and a failure to awaken in response to bladder sensations. Each mechanism can be supported by various studies, and no one theory is likely to explain bedwetting in all children. Excessive nocturnal urine production in some children is based on abnormal nocturnal plasma vasopressin release. […] Newer theories point to the role of the central nervous system in bedwetting. Parents of children who wet the bed often claim that they are deep sleepers. Children with nocturnal enuresis may, however, have sleep disruption.

• #2 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  The International Childrens Continence Society (ICCS) restricts the term enuresis to wetting that occurs at night. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. It is felt that the pathogenesis of PE is similar to that of SE. […] In PE, psychological problems are almost always the result of the condition and only rarely the cause. In SE, however, psychological problems are a possible cause, albeit not a common one. The comorbidity of behavioral problems is two to four times higher in children with enuresis. […] If no cause can be identified, the important pathophysiologic factors include a disorder of sleep arousal, nocturnal polyuria, and a low nocturnal bladder capacity.

• #2 Enuresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545181/

  Enuresis, commonly known as bedwetting, is a prevalent pediatric condition affecting approximately 15% of 5-year-old children. The condition is characterized by involuntary urination during sleep at least twice a week for 3 months in children older than 5. Enuresis is classified into 2 primary types: monosymptomatic enuresis, where bedwetting is the sole symptom, and non-monosymptomatic enuresis, which includes additional urinary symptoms such as urgency or frequency. […] This condition can lead to significant emotional distress, social isolation, and academic difficulties, particularly if not managed sensitively and effectively. […] The etiology of enuresis is multifactorial, with a solid genetic component influenced by physiologic and environmental factors. Children with 1 affected parent face a 44% likelihood of developing enuresis, and those with 2 affected parents have a 77% likelihood. […] The following list includes the potential causes of both primary and secondary enuresis: […] Children with NMNE typically have anatomic causes, including structural urinary tract abnormalities leading to impaired bladder function.

• #2 Bedwetting conditions | Children’s Hospital of Richmond at VCU

  https://www.chrichmond.org/services/urology/conditions-we-treat/bedwetting-nocturnal-enuresis/

  Bedwetting is a common problem for kids, especially those under six years old, and an issue many families face every night. […] While it is common, if it suddenly occurs or happens with other symptoms, it can be a sign of other medical conditions. […] The exact cause of bedwetting is unknown; however, it is thought to be due to a combination of physiological, learning, behavioral and emotional factors. There also appears to be a strong family component to bedwetting. […] Research has shown that if one parent has a history of bedwetting, their child has a 44 percent chance of wetting the bed as well. If both parents have a bedwetting history, the likelihood that their child will wet the bed increases to 77 percent. […] Studies have also shown that some children who wet the bed may have an abnormal level of antidiuretic hormone (ADH) in their bodies. This hormone helps the kidneys retain water, which decreases the amount of urine stored in the bladder through the night. Low levels of ADH in the body result in increased urine production and may contribute to nighttime wetting.

• #2 Enuresis in Children: Common Questions and Answers | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html

  Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older. […] Pathophysiology of primary monosymptomatic nocturnal enuresis may be due to sleep arousal disorder, overproduction of urine, small bladder storage capacity, or detrusor overactivity. […] Primary monosymptomatic nocturnal enuresis may be attributed to sleep arousal disorder, nocturnal polyuria, low bladder storage capacity, or detrusor overactivity. […] Nocturnal polyuria and large volume voids are present when the kidneys do not concentrate urine appropriately. […] Factors contributing to polyuria include drinking large volumes before bedtime; ingestion of large amounts of solute, such as salt or sugar; and decreased vasopressin release from the pituitary at night.

• #2 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Sleep studies reveal that children with enuresis do not wake up normally in response to an auditory signal; this finding confirms a problem in arousal. […] Studies reveal nocturnal polyuria in some but not all children with enuresis. Although nocturnal polyuria is important in the pathophysiology of enuresis, overproduction of urine per se cannot be the sole causal factor. […] Small functional bladder capacity (FBC) is now known to play a role in the pathogenesis of enuresis. […] Overactive bladder or dysfunctional voiding is more common among girls in preschool or elementary school, usually presenting with urinary frequency, urgency, squatting behavior, daytime wetting, and enuresis. […] Cystitis is a common cause of enuresis and an aggravating factor associated with other causes; cystitis associated with enuresis may present at any age.

• #2 The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study | Scientific Reports

  https://www.nature.com/articles/s41598-021-96519-w

  The results of this study showed that the FCs between lPVT and lNAc of PNE were lower than TD children, showing the pathway correlated with awakening were weaker. […] Higher the awakening score is, lower the degree of awakening ability is. […] Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children.

• #2 Nocturnal Enuresis (‘bedwetting’) in children | CUH

  https://www.cuh.nhs.uk/patient-information/nocturnal-enuresis-bedwetting-in-children/

  Nocturnal enuresis, the medical name for bedwetting, is involuntary wetting during sleep. Because nocturnal enuresis happens during sleep, the child is not conscious of the fact it is happening; it is out of your child’s control and so not their fault. […] Although we don’t know why some children achieve night time dryness quicker than others, nocturnal enuresis is likely to result from one or a combination of the following factors: […] Inadequate levels of Vasopressin. Vasopressin is an anti-diuretic hormone which means that it reduces the amount of urine produced by the kidneys. […] If levels of vasopressin are low the kidneys continue to produce large amounts of urine which the bladder cannot hold overnight and so bedwetting results. […] Overactive bladder is a condition in which the large bladder muscle (the detrusor muscle) contracts involuntarily and so the child experiences frequency, urgency and leakage of urine that can range from a damp patch on underwear to complete emptying of all urine from the bladder.

• #2 Nighttime Wetting | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/enuresis-nighttime-wetting/

  Bladder control is learned gradually, only after the child is old enough to understand that such behavior is desirable and can respond to praise and rewards. […] The conscious suppression of automatic emptying is first learned for daytime control. Eventually, the suppression signal to the bladder becomes automatic and does not require a conscious act by the child. Nighttime bladder control requires that the brain, during sleep, suppresses the automatic emptying reflex. […] Enuresis is not a psychological disorder, although secondary psychological problems may develop if there is tension between the child and the parent about the child’s delay in learning bladder control. […] DDAVP is a medication closely related to a naturally occurring hormone (ADH, antidiuretic hormone, also known as arginine vasopressin) that causes the kidney to produce concentrated urine. There are clinical studies showing that children with enuresis are not able to put out as much ADH during sleep as other children and, since the amount of urine in the bladder exceeds the capacity to hold it, wetting occurs. Some medical studies have shown that DDAVP may be effective in children shown to have some limitation in the ability to produce concentrated urine.

• #2 Case Based Pediatrics Chapter

  https://www.hawaii.edu/medicine/pediatrics/pedtext/s13c09.html

  Enuresis, commonly known as bedwetting, is one of the most common childhood urologic complaints encountered by pediatricians. Nocturnal enuresis (NE) refers to the involuntary passage of urine during sleep in a child at least 5 years of age. […] The pathogenesis of primary enuresis is multifactorial. Several important contributing factors include delayed maturation of voluntary cortical control of the micturition reflex, reduced nighttime antidiuretic hormone production, decreased bladder capacity, and impaired sleep arousal. […] Epidemiologic studies have shown that approximately 15% of enuresis cases resolve spontaneously each year, supporting delayed neurodevelopmental maturation as the main etiology. […] Decreased functional bladder capacity has also been shown in those with nocturnal enuresis as compared to normal peers.

• #2 Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association?

  https://smw.ch/index.php/smw/article/download/2270/3420?inline=1

  Nocturnal enuresis has been significantly associated with the presence of moderate-to-severe OSAS in a fully adjusted model considering tonsillar hypertrophy, obesity, gender and age. […] Increased intra-abdominal pressure caused by respiratory efforts against an obstructed airway has been implicated in the pathogenesis of nocturnal enuresis because of increasing bladder pressure. […] Urinary excretion of sodium and diastolic blood pressure have been found to increase in parallel with the severity of obstructive SDB. […] SDB can affect the secretion of urinary hormones such as atrial natriuretic peptide (ANP) and ADH. Nocturnal increase in ANP and a decrease in ADH are responsible for the nocturnal diuresis and natriuresis associated with OSA. […] Nocturnal enuresis may eventually be triggered by sleep apnoea because an accentuated negative intrathoracic pressure during sleep leads to abnormal secretion of ANP. […] Treatment of obstructive SDB, mainly due to tonsil and adenoid hypertrophy, leads to significant resolution of nocturnal enuresis in most patients, accompanied by normalisation of ADH, ANP and BNP levels, and concomitant improvement of HRQoL.

• #2 Enuresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545181/

  To understand the pathophysiology of enuresis, clinicians must first understand normal bladder maturation. At birth, voiding is uncontrolled. […] The majority of children with MNE will have spontaneous resolution of their symptoms, indicating a delay in normal bladder maturation. […] Children with nocturnal enuresis have increased nighttime urine output when compared to their peers without enuresis. […] The contribution of disturbed and excessively deep sleep to enuresis must be clarified. […] Children with enuresis have a higher arousal threshold during sleep and difficulty awakening. […] Enuresis often improves or resolves after tonsillectomy and adenoidectomy in these patients. […]

• #2 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Various common situations predispose to a psychological cause of enuresis, including birth of a new sibling, parental divorce or separation, death in the family, child abuse, or any other cause of social dysfunction at home or school. […] Constipation can cause both PE and SE and is a common aggravating factor that should be considered when other causes are present. […] Sleep-disordered breathing (SDB) is a disorder associated with both an abnormality in arousal and enuresis. […] A neurogenic bladder can result from a lesion at any level in the nervous system, including the cerebral cortex, the spinal cord, and the peripheral nerves. […] Urethral obstruction can be congenital (as with posterior urethral valves (PUVs), congenital stricture, or urethral diverticula) or acquired (as with a traumatic or infectious stricture or with meatal stenosis after circumcision).

• #2

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx

  Stress. This is one of the most common reason for secondary enuresis. […] Deep sleep. A deep sleep pattern can be part of normal adolescent development, as can a poor sleep schedule and too few hours of sleep. […] Obstructive sleep apnea/snoring. In rare cases, bedwetting happens because a child has obstructive sleep apnea and snores. […] Constipation. The bladder and bowels sit very near each other in the body. […] Bladder or kidney disease. This may be the case if a child has both daytime and nighttime bladder control problems and other urinary symptoms such as pain when peeing or the need to pee frequently. […] Neurologic disease. Sometimes a spinal cord problem that develops with growth or that is present early in childhood can cause bedwetting. […] Other medical conditions and/or medications. In rare cases, other medical conditions like diabetes cause enuresis in children.

• #2 Treatment for Bedwetting | Brown University Health

  https://www.lifespan.org/centers-services/childrens-rehabilitation-services/treatment-bedwetting

  Bedwetting, or nocturnal enuresis, is involuntary urination while asleep, after the age at which bladder control occurs. Most children start to stay dry at night around the age of three. However, it is not uncommon for children to continue to be wet overnight; up to one third of five- to six-year-olds experience nighttime wetting, and approximately 10 percent of seven- to eight-year-olds experience nighttime wetting. […] Causes of bedwetting are unknown, but common theories include: Increased urine production at night or not enough ADH antidiuretic hormone, Anxiety/ emotional issues, Family history, Deep sleep, Poor daytime voiding schedule, Constipation, Diet. […] About 20 to 30 percent of children with nocturnal enuresis are two to four times higher than non-wetting children to fulfill criteria for psychiatric disorder.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx

  Nocturnal enuresis, defined as nighttime bedwetting beyond age 5, affects many school-age children and even some teens. […] Although it is not completely understood why bedwetting occurs, it is thought to happen because of a delay in the development in at least one of the following three areas at nighttime: […] In babies and toddlers, links between the brain and the bladder have not fully formed; the bladder will just release urine whenever it feels full. […] This control usually develops during the daytime first; it takes more time before it happens at night. […] Bedwetting in this age group could be a sign of a urinary tract infection or other health problems, neurological issues (related to the brain), stress, or other issues. […] Other bedwetting risk factors: Genetics. If one parent wet the bed after 5 years old, their children may have the same problem about 40% of the time.

• #2 Patient education: Bedwetting in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics/print

  Bedwetting (also called nighttime or nocturnal enuresis) is a common childhood problem. Children learn to control daytime urination as they become aware of their bladder filling. Once this occurs, they learn to consciously control and coordinate their bladder. This generally occurs by four years of age. Nighttime bladder control usually takes longer and is not expected until a child is between five and seven years old. […] Bedwetting may be related to one or more of the following: The child’s bladder is maturing more slowly than usual; The child’s bladder holds a smaller-than-normal amount of urine; Genetics – Parents who had enuresis as children are more likely to have children with enuresis; Diminished levels of vasopressin (a hormone that reduces urine production); Deep sleep that prevents a child from sensing bladder fullness (this theory is controversial).

• #2 Bedwetting in Children | Health & Harmony Rx

  https://www.healthandharmonyrx.com/bedwetting-in-children.php

  Bedwetting, also known as or nocturnal enuresis, refers to nighttime incontinence in children once they have been toilet-trained. […] Bedwetting is more likely to occur in children who have a family history of the problem and in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). […] In the majority of cases, bedwetting simply indicates a slight delay in this particular area of development. […] Although there may be underlying physical causes of bedwetting, some of which may be serious, in most cases the causes are relatively benign. […] In some rare cases, bedwetting is the result of a neurological or urological defect. Only 5 to 10 percent of bedwetting cases are demonstrated to be the result of serious medical conditions. […] If an underlying disease condition or anatomical anomaly is found, then it must be treated to resolve the problem.

• #2 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Ectopic ureter is due to the insertion of the ureter in a location other than the lateral angle of the bladder trigone. […] Enuresis usually is not the presenting complaint in a child with new-onset diabetes mellitus. Conventional symptoms of insulin deficiency usually overshadow the presence of bedwetting. […] Diabetes insipidus is a very rare cause of enuresis.

• #2 Evaluation and management of enuresis in the general paediatric setting | Canadian Paediatric Society

  https://cps.ca/en/documents/position/evaluation-and-management-of-enuresis-in-the-general-paediatric-setting

  Serious medical conditions do not usually present as primary or secondary enuresis. […] Desmopressin works by decreasing both urine volume and intravesical pressure at night. […] Desmopressin is effective for treating enuresis with a range of underlying mechanisms and may be especially useful for nocturnal polyuria with normal (rather than low) daytime bladder capacity. […] Evidence is emerging for the benefits of combining treatments for enuresis.

• #2 Understanding Bedwetting in Kids | Lurie Children’s

  https://www.luriechildrens.org/en/blog/bedwetting-in-kids/

  Lifestyle changes and certain treatments help many children with primary enuresis and secondary enuresis. […] An alarm containing a moisture sensor can help develop the connection between a child’s brain and bladder. […] Alarms work for four out of five children, according to Freedman. […] Kids often benefit from changes that help them learn to recognize bladder cues during the day. […] Healthcare providers may recommend medications for some kids. Medications for bedwetting include: […] Desmopressin is a natural hormone released by the body at night. It helps decrease urine production. […] Oxybutynin is a medication that helps treat an overactive bladder. It helps improve bladder capacity and reduce bladder contractions. […] Bedwetting can be hard on a child’s self-esteem and confidence, according to Freedman. […] If you’re concerned about bedwetting in a child older than 5, don’t wait to get help, Ravoori says. Treating is important versus waiting for them to outgrow it, she says.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx

  Research shows that about half of children who properly use enuretic (bedwetting) alarms will stay dry at night after a few weeks. […] There are only two medications that have been approved for bedwetting: imipramine and desmopressin. […] It is important to note that bedwetting usually returns once medications are stopped, unless the child has „grown out of” nocturnal enuresis. […] Imipramine works well in some children with nocturnal enuresis. […] Desmopressin (DDAVP) helps to reduce the amount of urine your body makes. […] Bedwetting almost always goes away on its own. Most children will grow out of it by the late teenage years or sooner. […] Secondary enuresis may go away when the cause is found.

• #2 Nocturnal Enuresis (‘bedwetting’) in children | CUH

  https://www.cuh.nhs.uk/patient-information/nocturnal-enuresis-bedwetting-in-children/

  Anticholinergic medications relax the detrusor muscle that surrounds the bladder and can decrease involuntary bladder contractions and so help to enable the bladder to relax and hold more urine. […] Imipramine is a medication which is used to treat a variety of conditions. In children with bed wetting it may be a treatment option when other treatments have not been effective.

• #2 Enuresis – Bed wetting and Monosymptomatic Enuresis

  https://www.rch.org.au/clinicalguide/guideline_index/Enuresis_-_Bed_wetting_and_Monosymptomatic_Enuresis/

  Attaining night time continence is a normal developmental process, with significant age variation. There is a strong genetic tendency to bedwetting […] The pathogenesis involves several possible mechanisms including nocturnal polyuria, detrusor overactivity and an increased arousal threshold.

• #3 Bedwetting | Phoenix Children’s Hospital

  https://phoenixchildrens.org/articles-faqs/blog/bedwetting

  The majority of children with bedwetting fall into the primary nocturnal enuresis category, which is doctor-speak for children age 5 and older, who may have been successful in toilet training during the daytime, but have never been able to be completely dry during the nighttime. Waking up to urinate during the nighttime hours involves a complex communication between the bladder and the unconscious brain. This communication sometimes takes longer to develop in young children. […] Genetics could also play a role. Its been noted that a child with one parent who has a history of bedwetting will have a 40% chance of bedwetting as well. If both childs parents have a history of bedwetting, the likelihood jumps to 75%. […] One cause that wasnt listed is the decision of the child – thats because its often assumed bedwetting is the childs fault. This is not true. Waking up to prevent nighttime accidents is something that occurs to the unconscious child, which means its simply out of their control.

• #3 Enuresis – Bed wetting and Monosymptomatic Enuresis

  https://www.rch.org.au/clinicalguide/guideline_index/Enuresis_-_Bed_wetting_and_Monosymptomatic_Enuresis/

  Attaining night time continence is a normal developmental process, with significant age variation. There is a strong genetic tendency to bedwetting […] The pathogenesis involves several possible mechanisms including nocturnal polyuria, detrusor overactivity and an increased arousal threshold.

• #3 Patient education: Bedwetting in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics/print

  Bedwetting (also called nighttime or nocturnal enuresis) is a common childhood problem. Children learn to control daytime urination as they become aware of their bladder filling. Once this occurs, they learn to consciously control and coordinate their bladder. This generally occurs by four years of age. Nighttime bladder control usually takes longer and is not expected until a child is between five and seven years old. […] Bedwetting may be related to one or more of the following: The child’s bladder is maturing more slowly than usual; The child’s bladder holds a smaller-than-normal amount of urine; Genetics – Parents who had enuresis as children are more likely to have children with enuresis; Diminished levels of vasopressin (a hormone that reduces urine production); Deep sleep that prevents a child from sensing bladder fullness (this theory is controversial).

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