Bedwetting, also called enuresis, is a very common problem affecting children all over the world. By the age of 5 the majority of children will be dry at night. However some children can continue wetting their beds till they are in their teens and on rare occasions into adulthood.
In the past bedwetting was often treated as a psychological or behavioural disorder and children were often blamed or even punished for something that is now recognised to have mostly physical rather than behavioral causes. Treating bedwetting with punishment is not effective and only leads to depression and anxiety in the child [1].
Bedwetting can be due to several causes and its treatment should be based on proper diagnosis and individualised treatment that addresses the causes and related health issues.
Types of Bedwetting
Bedwetting is categorised as primary when there child has never been dry at night or secondary if the child has been dry for at least 6 months. Primary enuresis is the most common type.
Bedwetting is also categorised as either monosymptomatic enuresis (MNE) when the child does not have any daytime continence issues or urinary problems and non-monosymptomatic enuresis (NMNE) when they do.
These two types of bedwetting have different causes and require different treatments. NMNE is often due to bladder and lower urinary tract issues while MNE is due to issues connected to sleep and sometimes to airway insufficiency and breathing disorders.
Risk Factors for Bedwetting
Obesity, inflammation, bladder (detrusor) muscle overactivity, excess nighttime urine production, hormonal and metabolic disorders, autonomic nervous system dysfunction, airway insufficiency and sleep disordered breathing all contribute to enuresis [2, 3].
Airway insufficiency and sleep/breathing disorders are of particular importance because they can contribute to other established causes such as obesity, inflammation, excess nighttime urine production and hormonal/metabolic disorders.
Bedwetting, Sleep and Breathing
Bedwetting particularly when it is not associated with daytime voiding ie MNE, is strongly correlated with sleep disordered breathing [2]. Children who snore are four times more likely to wet the bed. Also 46% of children with SDB wet their beds [4]. They are also more likely to have ADHD, conduct disorders as well as learning disability[5].
Tonsillectomy can help [4] but does not necessarily cure it and perhaps only about 50% of children with enuresis are cured by adenotonsillectory [6].
Breathing exercises [7] and breathing exercises combined with pelvic floor exercises can have a significant impact on bedwetting and other health indices [8] including normalising oxygen and carbon dioxide levels [7].
Coming up next…
Why do Breathing Exercises Help Bedwetting?
Integrative Strategies for Bedwetting
References
- Al-Zaben, F.N. and M.G. Sehlo, Punishment for bedwetting is associated with child depression and reduced quality of life. Child Abuse & Neglect, 2015. 43: p. 22-29.
- Su, M.-S., et al., Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World Journal of Pediatrics, 2018.
- Hubeaux, K., et al., Evidence for autonomic nervous system dysfunction in females with idiopathic overactive bladder syndrome. Neurourol Urodyn, 2011. 30(8): p. 1467-72.
- Jeyakumar, A., et al., The association between sleep-disordered breathing and enuresis in children. Laryngoscope, 2012. 122(8): p. 1873-7.
- Esposito, M., M. Carotenuto, and M. Roccella, Primary nocturnal enuresis and learning disability. Minerva Pediatr, 2011. 63(2): p. 99-104.
- Kalorin, C.M., et al., Tonsillectomy does not improve bedwetting: results of a prospective controlled trial. J Urol, 2010. 184(6): p. 2527-31.
- Khaleghipour, S., M. Masjedi, and R. Kelishadi, The effect of breathing exercises on the nocturnal enuresis in the children with the sleep-disordered breathing. Iranian Red Crescent Medical Journal, 2013. 15(11): p. e8986-e8986.
- Zivkovic, V., et al., Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med, 2012. 48(3): p. 413-21.
