Enuresis (nocturnal): what is it? Understand the causes and treatment

What is enuresis?

Enuresis is an unfamiliar name for a disease that has bedwetting as a symptom. It is more common in children, but it can also happen in adults.

One of the definitions that exist for enuresis places it as a urinary incontinence without the presence of demonstrable organic causes, during an age that the affected individual already has control over the muscles that release or hold urine, called the urethral sphincter .

However, some professionals do not compare this condition with urinary incontinence, placing them as distinct diseases. What differentiates these two pathologies, therefore, is the phase in which it happens and the period.

Enuresis occurs predominantly in childhood and urinary uncontrollability occurs during sleep. It is an involuntary condition and the child only realizes that he wet the bed when he wakes up.

In order to diagnose a child with enuresis, it is necessary to observe the age, frequency and environment in which he is inserted, as social and psychological factors interfere in the appearance of nocturnal urination.

This pathology is present in 15% of children up to 5 years old, 3% at 10 years old and 1% in adults (over 20 years old), with boys being the most affected.

Enuresis or just normal urination?

For many children, it is normal for bed wetting to happen at one time or another. In addition, it is from the age of 2 that children begin to develop control of the sphincters, muscles that assist in the retention or release of urine and faeces.

At that moment, they are able to handle the urge to go to the bathroom more easily during the day.

However, this is a gradual process and will be “perfected” over time. It is also not a rule for all children.

It is believed that it is around 3 years of age that little ones start to have total bladder control during the day, no longer wetting the bed or clothes, since it is around that age that mothers start to take them out of diaper.

In cases where only a few “escapes” happen, it is not considered a cause for concern. It is normal for children to continue having daytime urination, eventually, up to six months after reaching that age.

After 1 year, there is nocturnal urinary contention. That way, we can get an idea of ​​when to start worrying about these urinations and differentiate it as enuresis. Before the age of 4 to 5 years, bed wetting is not considered a serious problem.

Therefore, in order to identify a child with enuresis, it is necessary to pay attention to their age, the times when urination occurs and the number of times the child needs to go to the bathroom, based on what is considered normal or ideal, which should be 4 to 7 times a day.

It is also necessary to realize if there is urgency in these episodes, if the child is not able to hold the pee for a long time, in addition to low back, abdominal pain and little water consumption.

With these signs, it is necessary for parents to start paying more attention and to see a doctor to investigate what is happening.

Types

There are two main types of enuresis: primary enuresis and secondary enuresis. This division is due to evolution.

We can also divide enuresis by symptoms, as monosymptomatic or polysymptomatic.

Some professionals also divide enuresis as nocturnal and daytime, but this statement is not certain, because when it happens during the day, we are referring to urinary incontinence, a different disease.

Understand the difference between types:

Enurese monossintomática

Monosymptomatic or simple enuresis is not related to any other urinary symptoms or to bladder (bladder) diseases during the day. It also has no neurological and urinary tract changes.

This type is very common, so much so that it corresponds to 70% to 90% of enuresis cases. Within this framework, the affected individuals do not show any change in the urine test or a history of urinary infections.

It is also common for people who suffer from monosymptomatic enuresis to have a family history of the disease.

Enurese polysintomatics

When it comes to polysymptomatic enuresis, there is an association with daytime symptoms, albeit with little urination.

The accompanying symptoms are an urge to urinate, a weak urination stream, urinary frequency (increased visits to the bathroom, but with little urination flow), urinary tract infections, fecal incontinence (encopresis) or difficulty in defecating.

Primary enuresis

In primary nocturnal enuresis (ENP), the child always presents this condition, and it may be necessary to use diapers.

It never stays dry overnight. When there is a pause in this lack of bladder control, he never exceeds a period of more than 6 months without urinating while sleeping.

Most cases of enuresis belong to this type. It is believed that delayed neurological maturation is the major cause.

There are some characteristics that people with primary nocturnal enuresis have, they are:

  • Uncontrolled urination only during sleep;
  • They do not have and do not have a history of urinary tract infection;
  • They did not suffer any accident that could have impaired their urinary function;
  • When awake, she has no urinary difficulties;
  • They have never had control over nighttime urination for more than six months.

Secondary enuresis

In this other type of the disease, enuresis occurs in children who have had a bladder control for more than 6 months, but have returned to bed-wetting, for reasons that can be varied.

This condition is more related to stressful social and family events than primary enuresis.

Causes of enuresis

Scholars have not yet reached a definitive conclusion about the disease, however, there are several situations that can influence the bladder, causing the patient to have enuresis. They are:

Neurophysiological immaturity

In neurophysiological immaturity, the child’s physical learning ability is compromised. This is because the brain area responsible for behavior and learning is poorly developed.

Consequently, the child will have some difficulties, such as learning or controlling the sphincters.

The main signs of neurophysiological immaturity are:

  • Behavior problems;
  • Lack of attention;
  • Lack of concentration;
  • Impulsivity;
  • Aggressiveness towards other children.

Lack of full bladder sensation

It is common for parents to initially believe that the child was too lazy to get up at night and therefore urinated on the bed, but this is not quite true. At least not in cases of enuresis.

The enuretic child does not feel a full bladder, with that he only notices that he urinated when he wakes up wet.

Low circulation of antidiuretic

The antidiuretic hormone (ADH), also called vasopressin, has as one of its functions to contain the expulsion of urine during the night, causing it to be stored until the next morning, when it will be expelled.

It is possible that enuretics have a low circulation of this hormone, or that their cycle is irregular, confusing night with day.

Sleep disorders

In some cases, bedwetting may be justified by the unusual sleep pattern. It does not exactly fit as a cause, but rather a common condition for children who suffer from bedwetting.

All people go through the stages of sleep, from the lightest to the heaviest. It is not an exclusive feature of enuretic children.

However, it is normal for these children to sleep more deeply, which prevents them from waking up before they perceive the body’s stimuli for urination.

Therefore, they also do not realize that they wet the bed and only realize it when they wake up the next morning.

Possible causes are also:

  • Decreased bladder capacity;
  • Emotional or social stress.

In adults

In adults who have not grown up with the disease, the causes can be:

  • Wear of the musculature necessary for the control of urine;
  • Polyuria (urinating in excess, above 2.5 liters per day);
  • Urinary infection;
  • Excessive consumption of alcohol, coffee or diuretics;
  • Sleep medications (as they make it difficult for a person to wake up to urinate);
  • Any type of diabetes;
  • Stress and anxiety;
  • Neurological problems, which result in neurogenic bladder (incapable due to the nervous system) and sleep apnea.

Enuresis in the elderly

Although bedwetting is more common in children, it can also affect other age groups, such as the elderly. Among the causes that can trigger this urinary lack of control are:

  • Diabetes;
  • Calculation of the urinary tract;
  • Urinary infections;
  • Neurological diseases;
  • Prostate cancer or enlarged prostate;
  • Bladder cancer;
  • Sleep apnea (pauses in breathing);
  • Acute anxiety (rarely);
  • Emotional disorders.

In addition to these indications, other factors may be related to enuresis in the elderly, such as the use of medications to get to sleep and the wear and tear on the muscles that control the bladder (sphincter apparatus).

Just as it is for the treatment of children, the elderly also need medical care to identify the cause and treat it. In some cases, it may be necessary to resort to the use of geriatric diapers.

It is important that family members are able to help the elderly who are going through this, as many may hide the picture because they are ashamed to talk about what is happening. The correct thing is that the patient is able to pass the symptoms he is feeling to the doctor, in addition to enuresis, in order to solve the problem.

At the consultation, the doctor can order a physical exam, neurological evaluation and urine collection for analysis.

Another test that can be performed is urofluxometry . In this exam, the patient needs to urinate in a specialized funnel, which measures the flow, amount and time required for the patient’s urination.

In addition, there is also the possibility of performing a measurement of residual urine, using an ultrasound to determine the amount of urine in the elderly’s bladder.

Groups of risk

There are some groups and risk factors within this pathology. Know what they are:

Family history

Children with family members, such as parents and siblings, who had enuresis, may belong to the risk group. This condition appears, in the majority, as a type of primary enuresis, when some chromosomal abnormality occurs.

If a parent had enuresis in childhood, the chance of the child developing is approximately 45%. When both parents had it, the odds go up to 75%.

Boys

Boys can be considered as a risk group, as they are more vulnerable to having the problem than girls. The incidence is two boys for one girl. This occurs due to slower maturation, which contributes to enuresis.

TDAH

Attention deficit hyperactivity disorder ( ADHD ) is considered a risk factor. Thus, children who suffer from this disorder are more sensitive to suffering from enuresis as well.

How is enuresis diagnosed

The diagnosis of enuresis must be carried out by a pediatrician . In cases where the disease manifests itself in adulthood or in adolescence, it is best to make an appointment with a urologist .

He is responsible for treating diseases related to the organs of the urinary system, both male and female. For children who are suffering from this condition, the pediatrician himself is able to diagnose and initiate treatment.

When the causes are related to psychological problems, it is possible that there is also a follow-up of other doctors specialized in the area of ​​care for emotional disorders, such as the psychologist himself.

The diagnosis should include analysis of the patient’s clinical history, urination and bowel habits and, when necessary, complementary exams, such as genital  and neurological physical examination .

In addition, other points that should be noted by the doctor are:

Age

The child’s age must be taken into account. It is normal for some children, when small, to end up wetting the bed.

However, when these urinations occur after the child turns 5 and on a constant basis, that is, more than 2 times a week and for a period of more than 2 or 3 months, it is a sign that something is happening, and may be enuresis.

Doctors recommend parents to be aware of their children who still urinate during sleep after 7 years.

Frequency

For doctors, the enuretic child, according to statistical criteria, pee in bed at least twice a week, within two to three months.

If the child urinated during sleep today and, after two weeks, urinated again, it does not indicate that he suffers from enuresis. That is, a child who has isolated episodes of nighttime urination does not fit within the disease.

However, it is also necessary for parents to seek help in these cases and support the child to solve the problem.

Family and psychosocial context

A child’s act of bed wetting may be related to family and psychosocial problems. In such cases, bedwetting can be a physical manifestation that something is affecting the child internally.

There are studies that reveal the frequency of cases where enuresis occurs in poorly favored social environments. There are also relationships with trauma in the first years of life, family conflicts and even the lack of breastfeeding.

Enuresis has a cure?

The enuresis curable . When the cause of the problem is identified and treated properly, affected individuals tend to stop urinating during sleep.

What is the treatment of enuresis?

The treatment of enuresis can be carried out in some ways, according to what is causing the urinary uncontrolled in the affected child or adults.

For children, within the treatment, the support of parents is essential in making them understand that there are ways to control and that there is no need to be ashamed of hiding from them what is happening to their bodies.

Know the ways to treat enuresis:

Therapy

Behavioral therapy is the first option in the treatment of children who are affected by enuresis.

This method of treatment includes some techniques for modifying children’s behavior. It is a stimulus for them to regain control of the bladder.

The most suitable behavioral therapy for patients in this setting is urinary alarm. Find out how it works:

Urinary alarm

The urinary alarm is a device that helps the child to wake up during the process of urination at night. It works through a kind of carpet with sensors that sense the urine.

They are connected to a speaker, which reacts with an alarm when the sensors detect the pee. They can be placed close to the child’s genitals, as in the mattress itself, for example. And so, the child wakes up when urinating.

At the beginning of this therapy, the child must wake up while urinating and may end up in the bathroom, but over time he / she will have more control of the bladder and wake up before wetting the bed.

Treat the causative disease

Some of the causes of bedwetting are stress , diabetes and psychiatric illnesses. In such cases, it is important to act to solve these problems, seeking the appropriate treatment for each diagnosis with a specialist.

Waking up the child to pee

One treatment option that can be tested by parents is to wake the child up at night so he can go to the bathroom to pee.

This strategy is for the child to learn to hold the pee well. Over time, she will understand, in a very natural way, that she needs to wake up to urinate and the nighttime urination, consequently, should decrease.

What is indicated is that parents wake their children at least 2 times a night and take them right after waking up to the bathroom. It is also recommended to encourage the child to go to the bathroom before going to sleep. One way to calculate times for your child to wake up is every 3 hours.

Kegel exercises

This is an exercise that serves to strengthen the muscles of the pelvic floor, that is, the muscles responsible for the functions related to the proper functioning of the urinary and anal sphincters.

Practicing exercises to strengthen this musculature contributes to the containment of urine and feces.

One way to understand if you are finding the right muscle is to try to stop the pee by making the contraction. If the urine stops, you are doing it correctly.

Although it is possible to do the exercises at home , it is essential to seek the accompaniment of a gynecologist or a physiotherapist specialized in pelvic physiotherapy.

This is an exercise that benefits both men and women. In addition to helping to control the bladder, preventing the risks of having urinary incontinence and enuresis, this exercise helps to prevent vaginismus for women and premature ejaculation in men.

One way to train this movement is, basically, to interrupt the spurt of urine for 10 seconds, return and repeat. Thus, what happens is as if the enuretic person is urinating several times during the same urination.

For children, it can be a fun exercise. One idea is to put it as a game or challenge, to encourage them to do it.

Medicines

Drug treatment can be used in conjunction with other methods. The use of medicines should be done only when the doctor understands that there is a need.

It is possible to reverse enuresis only with therapy, but in more complicated cases, the drugs help this process. However, drug treatment is not indicated for children under 5 years of age.

Change of habits

One way to treat enuresis is to induce a change in some children’s habits. Drinking less fluid around bedtime and avoiding acidic foods can help decrease this process of reducing nighttime urination.

When the enuretic child consumes a lot of fluids at night, the chances of continuing to urinate during sleep are greater. With acidic foods, the same thing, as they irritate the bladder.

Medicines

Within the treatment, it is possible that the doctor recommends the use of medications. Among the most prescribed, some of them are:

  • Anticholinergics ;
  • Imipramina;
  • Desmopressina (DDAVP);
  • Antimuscarinics;
  • Propriverine;
  • Oxibutinina .

Attention!

NEVER  self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living with bedwetting

Bedwetting is a disease that can cause a feeling of shame in the patient who suffers from this condition. Therefore, living with enuresis can be difficult for them. Fortunately, there is treatment, but it is a process that requires time, patience and support.

See how it is possible to live with enuresis:

Understanding family members

There may be two types of situation regarding how the parents of the children will respond to bedwetting. In cases where there is a positive and healthy reaction, parents can understand that what is happening to the child is an internal problem and that the child has no control over what is happening. It is not for want.

However, this is not the case in every home. It is common for some families to blame the child for bed wetting, as if it were intentional or even too lazy to go to the bathroom.

This behavior is extremely negative for children and for the treatment to occur properly. When they are not understood, they become more introverted and insecure.

One of the steps to have a recovery is the understanding of the parents. The child needs to feel that he or she can trust family members for the treatment to work and for it to improve little by little. Since one of the causes can be, precisely, conflicting family relationships.

We know that bedwetting can also happen in adults and that does not mean that it will be easier to deal with the disease. The person who develops this condition after adulthood may feel bad, in the same way that an older child does not feel well wetting the bed yet.

Therefore, family members should support and make the patient feel good to continue with the treatment. After all, there is no reason to hide bedwetting or be ashamed. The family needs to keep this in mind.

No pressure

Each patient may take a different time to finish the treatment and even to understand that what is happening can be diagnosed and treated.

For parents, it is important to understand that the child may take some time to stop urinating during sleep, and this is normal. Pressing it will not be beneficial and will not speed up this process.

No blame

The child or adult should not feel guilty about the disease. Nobody wants to be sick, it just happens. Therefore, parents and family members need to be patient and demonstrate empathy.

Thus, reacting with punishment and blaming is taking a step back in treatment. Telling the child that he or she is giving you trouble with washing clothes, extra expenses, smells and other repressions will make him feel worse about the condition that already affects him.

Rewards

This is one of the ways that can help the child during treatment. Parents can think of some way to congratulate them, with something symbolic like a hug or a star, each day they manage to control urination. It is a way to stimulate the child and make him happier with his progress.

Don’t wait for the disease to go away on its own

Enuresis has treatment and doctors who can help the patient with the disease. It is not healthy to expect this to resolve itself. The best thing to do is to investigate the cause and act on it.

Reduce fluid consumption at night

Enuretics should prefer to drink less fluids at night and go to the bathroom before going to bed. These habits can help decrease nighttime urination.

Complications

The complications that enuresis can cause are related to its social effects on the life of the person who suffers from the disease.

Self esteem issues

One of the problems that most affects the enuretic child is the fear of discovering that he or she pees on the bed. This fear can make you more withdrawn and isolated.

The fact that you can feel different from others or even feel guilty about night urination directly affects your self-esteem . As a result, their relationship with their parents, family and at school, for example, begins to be damaged.

How to prevent bedwetting?

To prevent enuresis, it is possible to adopt some health care measures. Know how:

Urine control

Some exercises can be performed in order to have more control under the bladder, thus avoiding involuntary urination.

It can be done once a week. This training serves to make it possible to identify when the bladder is full.

It should be done as follows:

  1. Water consumption: the child or adult should drink 3 glasses of water;
  2. Control: after ingesting the 3 glasses of water, it is necessary to control the urge to urinate for at least 3 minutes;
  3. Results: If the result is positive and the individual is able to withstand the 3 minutes, the next week should be done with 6 minutes. Thereafter, 9 minutes.
  4. Purpose: the person should be able to control the bladder for 45 minutes.

Mental health care

Bedwetting can be caused by some psychological disorder that the patient has. For children, changes in school, city and even the separation of parents can be a traumatic episode. Fears and insecurities can influence the appearance of these nocturnal urinations.

It is essential that the child feels safe and protected and that mental health is a priority as well. There are no mandatory rules and what would be essential when discussing mental health. There is no familiar structural model to be followed, but dialogue must be established.

Young children can demonstrate bedwetting as a sign that something is not right inside them. Talking about it can help you, and when done preventively. can prevent diseases like this from appearing.


Peeing in bed can be an indication that something is not going well, especially when it occurs in childhood. Stay tuned as it may be enuresis.

For patients, living with this pathology can be a difficult period and even a cause for shame, but it need not be so. There are ways to treat it and lead a comfortable life.

Share this text with your family and friends and contribute to let more people know about this disease.

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