It is common for many parents to go to the pediatrician with the concern that their child is still wetting the bed while sleeping, despite the fact that during the day they do notify when they want to go to the bathroom. This problem is known by the medical term nocturnal enuresis.

What is nocturnal enuresis? (to wet the bed)

Enuresis is a problem that consists of the involuntary loss of urine at any time of the day, although it is more common that occurs at night. It is striking that nocturnal enuresis not only occurs in childhood, but can also be seen in adults.

So if this disorder is suspected, its causes should be specified to provide the most appropriate treatment. In this article we will answer some very frequent questions about enuresis.

Why does a child wet the bed?

The first thing to specify is whether this situation is presenting itself as a primary form (the child has never stopped wetting the bed) or secondary (after the child spent the whole night without wetting the bed, the problem reappears).

Subsequently, the entire environment of the child should be evaluated, psychosocial problems, fluid intake, the frequency with which he urinates during the day, the weather, if someone else in his family wets the bed, how is the nutrition of the child and his personality.

Causes of enuresis or involuntary urination

The causes of a boy or a girl wetting the bed are varied and can range from local urinary tract disorders to systemic diseases and psychological causes.

Among the causes of this condition are:

• Urinary tract infections
• Neurological disorders that cause bladder motility disorders, such as neurogenic bladder.
• Type 1 diabetes mellitus, which is characterized by an increase in the frequency of urination, so in children glycemia (blood glucose) controls should be done to rule out this cause.
• Diabetes insipidus: produced by the decrease in levels of the hormone vasopressin (also called antidiuretic), which produces an excess of urine elimination.
• Sleep disorders such as obstructive sleep apnea.
• Urinary malformations such as urethral stricture and alterations in the anatomy of the ureters (structures that conduct urine from the bladder to the urethra), for example, the presence of ectopic ureters.
• Humid and cold climates.
• Psychological causes such as attention deficit and hyperactivity disorders, fear of staying alone in the room, fear of going to the bathroom alone, family losses, separations or, on the contrary, joys and anxiety.

According to the American Academy of Child and Adolescent Psychiatry, it is estimated that the majority of cases, of children who wet the bed, are attributable to psychological causes.

Can an adult wet the bed? Why is this happening?

The answer to the first question is yes. Unlike children, nocturnal enuresis in adults occurs mainly due to structural alterations of the urinary system and neurological disorders.

Among the structural alterations of the urinary system, the following are common: cases of vaginal prolapse; in addition to the cases of people with recurrent cystitis associated with urethral stricture, stones within the ureters or bladder, malformations in the ureters and bladder, among others.

On the other hand, neurological disorders, such as cerebrovascular accidents, degenerative diseases such as Alzheimer's, tumors of the nervous system and demyelinating diseases can cause neurological disorders at the bladder level, preventing its correct emptying, which causes the patient to wet the bed frequently and warrant the use of a diaper.

Some neurological disorders (stroke, head trauma, and tumors) can cause central diabetes insipidus.

Another important pathology to consider is Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus in adults, which can be a cause of increased voiding frequency. Constipation and the use of diuretics (medicines to urinate for any condition that warrants it) are also frequent causes, especially in elderly patients.

Finally, psychological causes could be ruled out in adults with a history of mental retardation, Down syndrome, schizophrenia, and other disorders.

How can nocturnal enuresis be treated?

In children, bedwetting can be considered a growth condition and can be accepted if it occurs occasionally. The pediatrician must emphasize that the child must urinate before sleeping, not consume liquids at night, condition the room so that they do not feel cold and the psychological support of the parents to face their fears, being sometimes necessary the evaluation of a child psychologist.

In children and adults, if a urological pathology is suspected, a urologist should be consulted to rule out that the patient requires surgery. In adults with neurological pathology, the reversibility of the urinary picture will be determined by the treatment of the underlying condition.

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