Nocturnal enuresis, or bed-wetting, is defined as unintended nighttime urination in a child over 5 years old. In most cases, there is no underlying medical cause, in which case the condition is called primary nocturnal enuresis (PNE). When enuresis occurs as a result of another illness, it is called secondary nocturnal enuresis.
In adults, when the bladder becomes full during the night, it signals to the brain that this has occurred; in turn, the brain informs the bladder not to empty and also begins the process leading to wakefulness. The ability to carry out this process is not present at birth, but most children gradually develop this capacity, and achieve it in full by age six. However, as many as 7% of 10-year-olds and 1%–2% of 15-year-olds continue to have trouble. Nearly all children with primary nocturnal enuresis will cease bed-wetting by the time they reach puberty. However, PNE remains a problem for up to 1% of adults.
Enuresis occurs more commonly in boys than in girls. In addition, there is a strong genetic predisposition: if both parents have enuresis, there is a 75% chance that a child will; this decreases to 40% if only one parent has enuresis.
Nocturnal enuresis is not a disease, but it can lead to significant embarrassment and limitation of activities, and for this reason treatment may be desired. The first step is a medical examination to rule out rare underlying causes, such as infection. Common sense steps follow, such as not drinking much liquid near bedtime, and voiding just before going to bed. More specific treatment can be delayed as long as desired because, in the great majority of cases, nocturnal enuresis will eventually disappear. For older children who wish to accelerate the process, nighttime alarm systems that wake the child in response to moisture in the child’s underpants are often highly effective. Other methods include bladder exercises and a schedule of planned nighttime waking. If these behavioral methods fail, use of various medications may be considered.
No one wants to give a healthy child medication, and for this reason many parents turn to alternative medicine for the treatment of nocturnal enuresis if behavioral methods don’t work. However, no alternative therapies have as yet been proven effective for this condition.
has shown some promise for nocturnal enuresis. In one study, 50 children were given either the drug imipramine, or hypnotherapy, for 3 months.
The results showed substantial and approximately equal benefits in the two groups. Subsequently, children in the hypnosis group practiced self-hypnosis for another 6 months, while those in the imipramine group did not utilize any special therapy. At the end of the 6 months, children practicing self-hypnosis had maintained their benefits to a much greater extent than those in the imipramine group. Other studies found benefits with hypnosis as well
; however, all had significant design limitations, and, overall, the evidence supporting hypnosis for nocturnal enuresis is not yet strong.
It has been suggested that
may play a role in nocturnal enuresis. However, there is only incomplete evidence that allergen avoidance or any other dietary approaches can help.
Herbs used for miscellaneous bladder problems are often recommended for nocturnal enuresis, on general principles. These include
. However, there is no evidence that these herbs help the condition, and some, such as uva ursi, may have toxic properties, especially when given for the long term.
Bach flower remedies
Chinese herbal medicine
are also sometimes recommended for nocturnal enuresis, but there is no reliable evidence that they are effective. One reasonably well-designed study found evidence that a special form of
(Activator technique) is
effective for bedwetting.
According to one small trial, laser
, which directs a laser energy at acupuncture points (instead of inserting needles), may help to reduce bed-wetting episodes.
A small preliminary study suggested that the use of
pulsed magnetic stimulation
day and night for two months may be helpful in girls.
Various herbs and supplements may interact adversely with drugs used to treat nocturnal enuresis. For more information on this potential risk, see the individual drug article in the
section of this database.
Banerjee S, Srivastav A, Palan BM. Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy.
Am J Clin Hypn
Mellon MW, McGrath ML. Empirically supported treatments in pediatric psychology: nocturnal enuresis.
J Pediatr Psychol
Egger J, Carter CH, Soothill JF, et al. Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.
Reed WR, Beavers S, Reddy SK, et al. Chiropractic management of primary nocturnal enuresis.
J Manipulative Physiol Ther
But I, Varda NM. Functional magnetic stimulation: A new method for the treatment of girls with primary nocturnal enuresis?
J Pediatr Urol.
Karaman MI, Koca O, Küçük EV, Öztürk M, Güneş M, Kaya C. Laser acupuncture therapy for primary monosymptomatic nocturnal enuresis.