Related concepts:

Bed-wetting, Primary nocturnal enuresis, PNE

Introduction to enuresis:

Most children learn how to stay dry during the day before they’re able to stay dry at night. Millions of kids wet the bed long after they feel that they should be dry.

Sadly, most of these children feel that they still wet the bed because there is something wrong with who they are. Many of them feel that it's the result of either bad thoughts or bad actions. They feel that somehow bed-wetting is a punishment.

Similarly, many parents feel that their children's bed-wetting is a result of a defect in their parenting. This feeling is heightened by well-meaning friends and relatives who bring up questions of emotional instability as the cause of bed-wetting.

In one survey of parents, 22 percent stated that they thought the reason their child wet the bed was laziness. This could not be further from the truth! Primary nocturnal enuresis is a common developmental phenomenon related to physical and physiologic factors. It does not come from emotional stress, poor self-esteem, or emotional immaturity.

What is enuresis?

Children who can control their bladders during the day, but who have never been dry at night for at least a six-month period, have what is known as primary nocturnal enuresis (PNE), the most common form of bedwetting.

Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.

In secondary enuresis, the key is finding out exactly what has changed. There might be a new psychological stress such as a divorce, a move, or a death in the family. It might be something physical: the onset of a urinary tract infection or diabetes, for example. It might be a situational change, such as altered eating, drinking, or sleeping habits. Clearly, something has changed. The first step in solving the problem is identifying any changes in your child’s life.

In any case, children who wet the bed have two things in common. First, they need to urinate at night. Not all children do. During the first months of life, babies urinate around-the-clock. Most adults, however, don't need to urinate at night (although a small percentage of the population will need to urinate at night throughout life). Sometime in middle childhood, most kids make the transition from urinating around-the-clock to only urinating during waking hours. There are three reasons why some children may still need to urinate at night:

1. There is an imbalance of the bladder muscles. (For example, the muscle that contracts to squeeze the urine out is stronger, at moments, than the sphincter muscle that holds the urine in.)
2. They have bladders that are a little too small to hold the normal amount of urine.
3. They make more urine than their normal-size bladders can hold, for several reasons:
   • They may drink too much. Drinking in the two hours before bed increases nighttime urine production.
   • They may be consuming a diuretic medication, a substance that directly increases urine output.
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