Sleep Enuresis - Causes, Diagnosis, Treatment | Tuck Sleep

Sleep Enuresis

Malia Jacobson
Definition

Sleep enuresis (also called nighttime urinary incontinence) is more casually known as wetting the bed. During sleep enuresis, the brain doesn’t signal the body to wake when the bladder is full.

What is Sleep Enuresis?

Sleep enuresis (also called nighttime urinary incontinence) is more casually known as wetting the bed. During sleep enuresis, the brain doesn’t signal the body to wake when the bladder is full.

Sleep enuresis in childhood is common and typically outgrown, so this parasomnia is not diagnosed as a sleep disorder until after age 5 or 6. Up to 10 percent of children wet the bed at age 8; around 2 percent of adults experience ongoing sleep enuresis.

Symptoms of sleep enuresis are wetting the bed more than twice per month for three months for children over 5, or once per month past age 7.

What causes Sleep Enuresis?

During sleep enuresis, the brain doesn’t signal the body to wake when the bladder is full. Constipation is an underappreciated cause of sleep enuresis, because a full colon puts excessive pressure on the bladder.

Sleep enuresis in children can be caused by behavioral factors, stress, or anxiety. Like other parasomnias, enuresis may be inherited; up to 77 percent of children with parents who wet the bed in childhood will experience enuresis. Delayed physical maturity and abnormal levels of antidiuretic hormone (ADH), related to urine production, can also contribute to sleep enuresis.

Enuresis in adults in relatively rare and may signal one or more underlying medical conditions, including:

  • Diabetes
  • Constipation
  • Kidney problems
  • Bladder dysfunction
  • Urinary tract infection
  • Abnormal levels of antidiuretic hormone (ADH)

Diagnosis

When diagnosing sleep enuresis, doctors consider the frequency of bedwetting and the age of the patient. Sleep enuresis isn’t diagnosed in children under 5. Urinalysis, ultrasound imaging and urodynamic studies are used to determine whether underlying bladder infection or bladder dysfunction are factors.

Treatment

Sleep enuresis is primarily treated with behavioral interventions. These include reward charts, dietary changes, and reducing fluid intake before bed.

If these interventions aren’t successful, the next steps may be an enuresis alarm, either alone or combined with medication. Enuresis alarms wake the person (and sometimes, the entire household) immediately, helping build awareness of physical cues signaling a full bladder. The medication desmopressin decreases urine production to help treat bedwetting.

Additional resources
Parasomnias
Sleep disorders in children
Mattress protectors