Nightime bedwetting or nocturnal enuresis is a common phenomenon among children younger than five years of age. However, among children older than five years, night time bed wetting that occurs more than twice a week is a cause for concern.

Diagnosing nocturnal enuresis

Diagnosis of the condition involves obtaining a detailed history of the child's symptoms and the frequency of their bedwetting. Parents are asked to keep a diary recording the number of times per week the child has wet their bed as well as daily recordings of their fluid intake, toilet visits, and voiding volume. The child is then examined and tests are run to rule out other underlying conditions.

Some of these tests include:

• Blood sugar assessment to check for type 1 diabetes
• Urine analysis if urinary tract infection is suspected
• An abdominal ultrasound to test for urinary tract disorder and the presence of stones

Treatment

In the majority of cases, childhood bedwetting does not require any specific treatment and usually resolves with parental support and lifestyle modifications. Such lifestyle alterations include:

• Reducing and controlling the child's fluid intake, especially during the evening before bedtime. The amount of fluid a child aged 4 to 8 years requires is around 1.5 litres per day.
• Eliminating the child's intake of caffeine-containing drinks such as hot chocolate or Coca-Cola, prior to bedtime.
• Allowing the child to empty their bladder before bedtime. A healthy child passes urine at least 4 to 7 times during the day.
• Not reprimanding or punishing the child for bedwetting as this raises the child's anxiety level and reduces their self esteem, only increasing the likelihood of bedwetting. Rewarding the child, however, for adhering to agreed lifestyle changes may help reduce bedwetting episodes.

Managing bedwetting

Petroleum jelly applied to the child's buttocks and inner thighs can help prevent rashes associated with frequent bedwetting. Waterproof bed sheets and disposable diapers can be used to keep the child dry at night. A bedwetting alarm can be used to help parents monitor the frequency of bedwetting as well as to help the the child become adjusted to waking up and going to pass urine during the night.

Specific therapies

Specific therapies may be used to treat children with underlying causes of bedwetting and these include:

• Antibiotic treatment for urinary tract infections
• Glucose lowering treatment for type 1 diabetes
• The prescription of desmopressin, a synthetic form of the hormone vasopressin which regulates urine production
• The use of oxybutynin to relax the bladder muscles and increase its capacity to hold urine
• The use of imipramine to treat mood disorders that may be exacerbating bedwetting, such as panic disorders or depression