What is Nocturnal Enuresis?

Nocturnal enuresis is, by definition, urinary incontinence during sleep, more commonly referred to as bed wetting. The diagnosis of enuresis is reserved for those who have two or more bed wetting episodes per month. There are two main types of enuresis: primary and secondary.

Primary enuresis is a term coined describing patients who have never achieved bladder control. While secondary enuresis is the development of bed-wetting after urinary continence has been previously attained. In children, secondary enuresis is more likely to be associated with an organic disease while primary enuresis is likely to reflect a developmental delay in bladder stability in an otherwise healthy child.

Like all developmental milestones, the age at which children achieve urinary continence varies from one child to another. Typically, only 25-30% of children are continent at night at the age of four. Nocturnal enuresis is usually not diagnosed until the age of seven. In younger children, it is simply referred to as nighttime bed wetting. There is also a general familial tendency for nocturnal enuresis where the risks climb significantly (up to 80%) if both parents suffered from it as children.

If enuresis is accompanied by any other symptom, it is imperative to exclude diseases, which cause an increased urine output (diabetes mellitus and insipidus) and urinary tract infections. Patients should be on the lookout for symptoms like a burning sensation during micturition, bloody or clouded urine, pain in the flanks and frequency.

The psychological component of the disease also should not be overlooked. It is an all too common scenario that a child starts to lose nighttime continence if there is a stressful or disturbing event in his/her life, like the birth of another sibling, bullying and physical or emotional abuse to name a few.

Nocturnal enuresis can represent a source of embarrassment and lasting psychological damage. Seeking professional help early after failure of initial toilet training can diagnose any pre-existing conditions early and help parents and children cope better with the disease.

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