The actual causes of bedwetting, or nocturnal enuresis, often differ from parental perceptions. In the August 2006 issue of the "American Journal of Nursing," Amanda K. Berry wrote that while most parents understand that children cannot control their bedwetting, as children grow older, parental tolerance decreases and mothers in particular are more likely to blame the child. Bedwetting can occur at any age, but physicians do not consider it a cause for concern in children younger than the age of 6. The condition is not caused by laziness or lack of self-control. There are real physical, developmental and genetic causes of bedwetting.
Maturational Delay
Maturational delay is the most common cause of childhood bedwetting. By age 5, most children have the neuromuscular control required for bladder control. For some children, that control takes longer to develop. Some children may also have developmental issues with their bladder muscles. The sphincter muscle, which controls urine flow, may be weaker than the muscle that tightens and releases urine. Children who experience nighttime bedwetting, or nocturnal enuresis, may also have smaller bladders than non-enuretic children. Children with maturational delays do tend to outgrow them. Just 1 percent of children with nocturnal enuresis continues to have the problem as adults. Still, parents should never take a wait-and-see approach. Enuretic children older than age 5 should always be evaluated by a pediatrician.
Attention-Deficit Hyperactivity Disorder
There is a strong correlation between bedwetting and ADHD. Children diagnosed with ADHD are 2.8 times more likely to be enuretic than children without ADHD. In a January 2009 article published in the "Journal of the American Academy of Child & Adolescent Psychiatry," Srirangam Shreeram, M.D., stated that children diagnosed with ADHD and receiving medication for their condition are less likely to experience enuresis than ADHD children not taking medication. Shreeram also reported that 7.4 percent of children taking ADHD medication reported enuresis whereas 14 percent of children not taking ADHD medication reported enuresis. Children with ADHD are more likely to receive medical treatment than children with enuresis. This indicates that children diagnosed with ADHD should also be evaluated for nocturnal enuresis.
Genetics
If a child has parents who both experienced enuresis as children, the child has a 77 percent chance of having enuresis. If just one parent has a history of enuresis, there is a 44 percent chance that a child will inherit the disorder. Just 15 percent of children with nocturnal enuresis have no family history of the disorder. Three different genes are associated with nocturnal enuresis. The gene ENURI 1 is located at chromosome 13, ENURI 2 at chromosome 12 and ENURI 3, the most recently discovered gene, at chromosome 22.
Medical Conditions
Nocturnal enuresis can be an early warning sign of childhood diabetes. Typically the enuresis will be accompanied by other symptoms such as increased fluid consumption, weight loss and an increase in the volume of urine. Nocturnal enuresis accompanied by daytime enuresis may be the result of a urinary tract infection. Additional symptoms include painful and frequent urination.
References
- "American Journal of Nursing"; Helping Children with Nocturnal Enuresis ; Amanda K. Berry M.S.N., R.N., C.R.N.P.; August 2006
- Medline Plus: Urination
- "Journal of the American Academy of Child & Adolescent Psychiatry"; Prevalence of Enuresis and Its Association with Attention-Deficit/Hyperactivity Disorder; Srirangam Shreeram; January 2009
- "American Family Physicians"; Primary Nocturnal Enuresis: Current Concepts; Marc Cendron, M.D.; March 1999
- "Pediatrics: Just the Facts"; Thomas Green, M.D.; July 2004
