Myths and Facts

Sinha and Raut (2016) detailed some myths and facts. This review is going to focus on the etiology or causes of bedwetting.

  • Genetics – there is a known genetic link if both parents wet the bed their child has a 77% risk of wetting the bed.
  • Sleep Aspects – this is a debatable reason for wetting the bed.  It’s unknown if wetting is more associated with deep or light sleeping without arousal to needing to void.  Having an overactive bladder day and night might make the child less likely to notice the signals of needing to void while they are sleeping. Sleep apnea and snoring are associated with wetting but it’s unclear if it’s because of constant stimuli or increased urine production from abnormal thoracic pressure.
  • Maturational Delay – some studies have shown bedwetting increase in kids with delayed speech and motor performance.  As the brain matures signals are more easily received from the bladder.  Bedwetters have been noted to have smaller functional bladder capacities as well.
  • Nocturnal Polyuria – increased urine production throughout the night due to increased drinking at night, decreased antidiuretic hormone at night or poor response to the hormone.
  • Role of Antidiuretic Hormone – it’s unclear if this hormone is decreased primarily or secondarily.  Bladder distension can trigger increased antidiuretic hormone secretion. This would explain the high volume of urine but not the inability to wake up to the signal of needing to void.
  • Psychosocial Factors – bedwetters have an increased odds of also having attention deficit disorder by 2.88 times. It’s unclear which one impacts the other.
  • Adverse event to medications – the few medications that could increase the chance of wetting are lithium, valproic acid, clozapine, and theophylline.

My opinion: It’s important to get to the root of why bedwetting is happening when it is a new symptom.  If they’ve had 6 months of previous dry nights, I really want to investigate what triggered this new problem.  When it has happened all of their lives the exact cause is less important to me. Resolution is where I put all of my focus initially.  If they have a normal urinalysis, no daytime symptoms, and they’ve wet all of their lives, I focus on healing their bladder, improving their sleep, increasing daytime hydration, and then focusing on the difficulty to sense signals from their bladder. If they are not improving after 3-6 months of treatment then I question whether they need a sleep study, more diagnostics or considering a  medication change if the are on a possibly adverse medication.

Sinha, R., & Raut, S. (2016). Management of nocturnal enuresis – myths and facts. World Journal of Nephrology,5(4), 328.