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ABOUT PRIMARY NOCTURNAL ENURESIS

Primary nocturnal enuresis (PNE) is widespread, and is the most common chronic ailment in children besides allergic disorders1, affecting approximately 16% of 5-year-old children2.

PNE is a distressing condition that can have a significant impact on a young person’s behaviour and their emotional and social wellbeing3,4.

  • 32.5% of children (aged 9) rated wetting the bed as a ‘quite difficult’ life event for them4
  • They rated bedwetting to be comparable to how they felt about being teased or not being able to spell properly4

The burden of PNE on children and their families is considerable5.

PNE can be a persistent problem, and 10% of enuretic children will remain bedwetters for life1.

Enuretic symptoms in adolescent subjects were more severe than those in children2. This shows early intervention
can be key in PNE.

CAUSES

Most cases of PNE have two main causes:

 

Neurological-developmental delay

This is the most common cause of bedwetting. Most bedwetting children are delayed in developing the ability to stay dry and have no other developmental issues2,6. Bedwetting may be due to a nervous system that is slow to process the feeling of a full bladder1,7.

Genetics

Bedwetting has a strong genetic component. Children whose parents were not enuretic have a 15% incidence of bedwetting. However, when one or both parents were enuretic, the rates jump to 44% and 77% respectively8.

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It is generally accepted that there are three principle physiological aetiologies:1,9

 

  • Excessive night-time urine volume

    Due to low vasopressin levels, and subsequently, a reduced or absent nightly spike in vasopressin concentration which normally keeps bladder volume from reaching capacity until morning1,9

  • Poor sleep arousal

    If the child does not wake at the feeling of a full bladder, the child will more likely wet the bed1,9

  • Bladder contraction

    The muscles of the bladder can suddenly contract before the bladder is full9

 

Nocturnal enuresis (NE) is also linked to one (or a combination) of the following factors: anxiety, stress, small bladder size, constipation, and urinary tract infection7

It is important that children suffering with PNE are diagnosed early and are offered an appropriate treatment intervention1

DIAGNOSIS AND MANAGEMENT

A child’s treatment plan depends on:10

 

  • How often they are wetting the bed
  • The impact that bedwetting is having, on the child and their family members
  • The child’s sleeping arrangements
  • Whether there is a short-term need to control a child’s bedwetting
  • How the child feels about specific treatments

 

The burden of PNE on children and their families is significant5; however, effective treatment benefits all parties6.

  1. Hjälmås K. Acta Paediatr 1997;86(9):919–22.
  2. Yeung CK et al. BJU Int 2006;97(5):1069–73.
  3. Janknegt RA et al. J Urol 1997;157(2):513–7.
  4. Butler R and Heron J. Child: care, health and development 2007;34:65–70.
  5. van Kerrebroeck PEV. BJU Int 2002;89(4):420–5.
  6. Warzak WJ. Clinical Pediatrics 1993;32:38 -40.
  7. DryNites, Kimberly Clark Inc. 2015. Enuresis and Information and Advice For Children With Bedwetting Problems. Available at http://www.drynites.co.nz/enuresis. Date accessed: March 2023
  8. Sinha R, Raut S. World J Nephrol 2016;5(4):328-38
  9. Nevéus T. Pediatr Nephrol 2011;26(8):1207 -14.
  10. NHS Direct Wales. 2017. Bedwetting. [ONLINE] Available at: http://www.nhsdirect.wales.nhs.uk/encyclopaedia/b/article/bedwetting/ Date accessed: March 2023.

Job Code: UK-MN-2200029 - Date of preparation: March 2023

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