Sleepwetting Forum Articles

[ sleepwetting a.k.a. nocturnal enuresis or bedwetting]

from Spontaneous Combustion

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Developmental Causes and Contributing Environmental Factors

Sleepwetting is often thought of as an on/off [wet/dry] situation rather than a spectrum of ability ranging from bladder doesn't get full during night or person wakes up easily if full at one end of the scale to bladder fills several times a night and always empties before awakening person at the other end.

Sleepwetting is not just a concern for those who never have a dry night. Many children spend some time passing through the middle of the spectrum where they have a mix of wet and dry nights but little certainty of which it will be on any particular night. Even though this uncertainty reflects growth and progress, it can increase the frustration of the child and family, particularly if the child is moving into preteen or teen years and if any family members believe the wet/dry uncertainty means the child is lazy, not trying, or even wetting on purpose. Some children find it easier or safer emotionally to pretend they don't care than to admit trying and failing at something society tells them they ought to be able to do. Children who perceive their parents as resentful, distrusting, frustrated, or embarrassed may have difficulty participating in sleepwetting management and reduction programs. Criticism or punishment for sleepwetting, including blaming or shaming, can often have the reverse of its intended effect. A child who goes to bed anxious or fearful about waking up wet is more likely to do so.

Reducing or ending sleepwetting by children and teens is often not an easy task as there is usually a Developmental Cause [most often #1, #2, or both] as well as several of the Contributing Environmental Factors present that keep a child from moving toward dryness or make progress erratic. Until all such issues are identified and properly addressed there is little likelihood of consistent success.

Developmental Causes

These are physical or neurological factors, possibly hereditary, that a child may be born with. Some may be altered medically and others may be outgrown, but most can be compensated for.

Hormone level may be inadequate to suppress kidney output during night. This may be outgrown as early as the end of infancy, as late as the end of puberty, or not at all. [see Kidney Output and DDAVP ] A noticible increase in kidney output both day and night accompanied by increased thirst may be a sign of diabetes.
Depth of sleep and when during sleep cycles the bladder gets full can affect how bladder contractions are communicated to, received, or acted on by the brain.
Underdeveloped or small bladder for age results in low bladder capacity relative to kidney output and length of sleep.
Poor muscle tone in the outer sphincter or pelvic floor muscles can reduce the ability to resist bladder contractions and cause urgency or leakage.
Immature or damaged nervous system, including some types of seizures, may leave pathways to the brain unresponsive for control when asleep. If sleepwetting is associated with wetting when awake or loss of bowel control as well, check for possible spina bifida occulta (hidden) or other neurological disorders.
Anatomical irregularities in size, shape, and/or relation of ureters, bladder, urethra, and sphincter muscles can cause incomplete voiding, leakage, or urgency. A complete urological exam may be necessary to identify internal irregularities and determine the need for corrective surgery.
Premature wave contractions in the bladder walls result in feeling the need to empty the bladder before it is full.

Contributing Environmental Factors

These factors originate outside the child's urinary system. Particular children are more sensitive to some than to others. Once identified, these factors often may be eliminated entirely or controlled or compensated for on a day-by-day basis.

There are a variety of factors which separately or in combination may reduce bladder capacity, increase frequency of urination, or cause premature voiding.

allergies and reactions to pollens, medications, foods, and other chemicals [see dietary factors below]
pressure from constipation and full bowels
urinary tract infections
reduced liquid intake leading to strong concentrated urine
enterobius (pinworms) an intestinal parasite that may irritate bladder and urethra, particularly in girls
side effects of medical conditions such as seizures or tourette syndrome
tension and other stress on the nervous system
incomplete voiding, a poor toileting habit which may have both anatomical and environmental causes

Some situations or conditions may make it harder for a person to awaken in response to full bladder pressure.

increased depth of sleep from lack of sleep, excessive tiredness, irregular bedtimes
snoring or sleep apnea reducing oxygen in the blood stream
regularly being taken from bed by someone and encouraged to void while not awake
sleeping in a cold room
sleeping in bedding or nightclothes with a urine smell
sleeping near someone who sleepwets, particularly in the same bed
going to sleep with mind focused on the certainty of sleepwetting because of
- reminders of repeated attempts at cures ending in failures
- guilt or belief in responsibility for failure to sleep dry
- fear of punishment for sleepwetting
- anxiety about being found out or about teasing or harassment
- being treated as an infant/toddler emotionally or physically

Some factors may increase or work against decrease of kidney output at night.

early bedtimes
increased liquid intake in the two hours before bedtime
allergies and reactions to pollens, medications, foods, and other chemicals
side effects of medical conditions such as diabetes
temporary hormonal changes
travel and time zone changes

Dietary Contributing Factors

Some foods and beverages are possible contributors to sleepwetting. Their effect on the urinary system is not always understood. These range from allergic reactions that can cause the bladder to 'sneeze' even though not full to more subtle effects on muscle tone, neurological response, kidney output, and sleep patterns. Before starting any program of exercises, alarms, etc., it may help to note what items in the list below are in the current diet. Then try to eliminate all those items for one week. If there is a decrease in sleepwetting or other noticeable improvement in bladder control, slowly add items back to the diet one at a time in order to identify any offending items.

The following [roughly ranked from more to less common] are known to be contributing factors in some children:

caffeine, found in coffee, tea, chocolate, many soft drinks, some medications
milk/milk products [may be okay morning and mid-day, but not evening when the longer time taken to digest milk compared to other liquids can delay the processing of water from it by the kidneys until after bedtime]
citrus and some tropical fruits, particularly pineapple
artificial sweetener
carbonated beverages
tomato-based products
highly spiced foods
refined sugar, honey, corn syrup

Try to keep aware of general liquid intake and urine output on a daily basis. A person participating in a program to reduce sleepwetting does not need to reduce total liquid intake. In fact, drinking more liquid during the day can help kidney and bladder function and can only marginally increase existing sleepwetting while making it easier to learn techniques to decrease it. Try to double liquid intake before four pm. From dinner on, cut back to enough liquids to quench thirst, but don't make an issue of it. The type of liquid may make more difference than how much. Besides plain water, several fruit juices (grape, cranberry, apple, and cherry) are good thirst-quenchers not usually irritating to the bladder. Also cranberry and blueberry are known to help control urine odor and reduce bladder irritation and urinary tract infections.

disclaimer:

I am NOT a medical professional and do not offer advice that should be taken as medical or therapeutic in intent. Always consult a doctor for medical diagnoses and treatments. I have researched the area of teaching bladder control and managing bladder disabilities as part of volunteer work with incontinence support organizations and families of children with disabilities. I am a writer, actor, storyteller, children's bookseller, and parent of two young adults. I serve as list owner of the e-mail lists EnuresisKids [moderated] and EnuresisParents.

Tom Farley