Bed Wetting
Hey there, Bestie! It’s been awhile so let’s jump right into our chat. Today, I thought we could talk about a little something called childhood nocturnal enuresis (CNE), otherwise known as bed wetting! Bed wetting is pretty common in young kids, but when is it considered abnormal and what does it say about your pelvic floor function? Let’s chat about it!
CNE is defined as the involuntary loss of urine during sleep that occurs two or more times per week in children that are potty trained (1). It is more common the younger the child three times more common in boys compared to girls (1). It’s diagnosed when symptoms have been ongoing for three or more months and is one of the most common urologic complaints in children (1). CNE is diagnosed as either primary CNE or secondary CNE. Primary CNE occurs when the child has not experienced six months of dryness. In other words, the child has not had a period of six consecutive months without wetting the bed (1). Secondary CNE occurs when bed wetting begins after a period of six or more months with no bed wetting (1). It is important to understand both the pattern of bed wetting and the cause of the bed wetting in order to find the appropriate treatment.
Treatment for CNE:
As with anything, the treatment for CNE largely depends on the underlying cause of the condition. CNE can be the result of an overactive bladder (OAB), behavior, recurrent urinary tract infections (UTIs), sleep disorders, constipation, and more. It is essential to treat the cause of the CNE in order to improve CNE symptoms. Here are some treatment options relating to the potential causes of CNE:
- CNE related to OAB: OAB and other bladder dysfunctions are associated with CNE (2). There are many possible treatments for overactive bladder in children, but one of the more common treatments is transcutaneous electrical nerve stimulation (TENS) (3). Home TENS therapy has been shown to be safe and effective in the treatment of OAB in children and may help improve CNE (3).
- CNE related to behavioral causes: Behavioral modifications can include restriction of fluid intake for two hours before going to bed and even restriction of dairy for four hours prior to bedtime (1). It is also important to ensure that the child urinates right before bed (1).
- CNE related to constipation: In all children with CNE, constipation should be considered as an underlying cause and should be treated first (1). Treatment for constipation can include adjusting toileting posture, increasing dietary fiber, increasing fluid intake, utilizing daily colon massage techniques, addressing any scar tissue restrictions that are present in the abdomen, and increasing activity level.
- CNE related to sleep disorders: Sleep disorders such as sleep-disordered breathing can result in bed wetting. Children that do not wake easily may also be more likely to suffer from CNE. One treatment option here is an enuresis alarm. This alarm is embedded into a pad that the child sleeps on and it goes off when it detects wetness. This should wake the child and overtime help train their body to wake in response to needing to urinate (4).
- CNE related to polyuria: Polyuria occurs when you urinate more than normal. Some medications can reduce polyuria (including desmopressin) and have been shown to improve CNE (4).
- CNE related to UTIs: The UTI should be treated with a course of antibiotics in order to resolve the cause of the CNE. In a child with recurrent UTIs, parents should talk with the child’s medical providers about why UTIs are recurring and how to reduce the frequency of UTIs.
Many of the above-mentioned treatments are used in conjunction with one another. As we know, usually there is not just one singular cause of a set of symptoms and instead, the symptoms are the result of multiple factors. A multidisciplinary approach to treatment of CNE will likely result in the best outcomes for the child.
What does CNE say about the pelvic floor?
While CNE may seem like a benign condition, it can result in poor self-esteem and self-isolation (1). While most (>98%) children will “outgrow” CNE by the age of 17, even without treatment, certain symptoms can persist into adulthood (5,6). An interesting study from 2021 looked at the association between CNE and adult pelvic floor disorders (PFDs). The researchers found that the chances of experiencing PFD and lower urinary tract symptoms were twice as high in nulliparous women with a history of CNE compared with those without CNE (6). This is an intriguing association and leads readers to wonder whether PFD present in children with CNE persists into adulthood if left untreated. More studies will have to be done in order to fully understand the relationship between CNE and adult PFD.
If you’re an adult experiencing PFD, did you have CNE as a child? I’m curious about your experience! Let’s chat real soon.
XOXO,
Your Pelvic Bestie
References:
1. Gomez Rincon M, Leslie SW, Lotfollahzadeh S. Nocturnal Enuresis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545181/
2. Nevéus T. Pathogenesis of enuresis: Towards a new understanding. Int J Urol. 2017 Mar;24(3):174-182
3. Casal-Beloy I, Somoza Argibay M, García-González AM, García-Novoa. At-home transcutaneous electrical nerve stimulation: a therapeutic alternative in the management of pediatric overactive bladder syndrome. Cir Pediatr. 2020; 33(1): 30-35
4. Peng, C.CH., Yang, S.SD., Austin, P.F. et al. Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis. Sci Rep 8, 16755 (2018). https://doi.org/10.1038/s41598-018-34935-1
5. Milsom I, Altman D, Cartwright R, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal (AI) incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, et al., editors. Incontinence. 6. Paris: Health Publications Ltd; 2017. pp. 6–16.
6. Loeys B, Hoebeke P, Raes A, Messian L, de Paepe A, Van de Valle J. Does monosymptomatic enuresis exist? A molecular genetic exploration of 32 families with enuresis/incontinence. BJU Int. 2002;90:76–83. doi: 10.1046/j.1464-410X.2002.02775.x.
7. Othman JA, Åkervall S, Molin M, Gyhagen M. Childhood nocturnal enuresis-a marker for pelvic floor disorders and urinary tract symptoms in women? Int Urogynecol J. 2021 Feb;32(2):359-365. doi: 10.1007/s00192-020-04345-x. Epub 2020 May 30. PMID: 32474636; PMCID: PMC7838072.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
