Other names :
Being unaware of passing urine during deep sleep.
Normally, urine is retained in the bladder by the contraction of a ring shaped bundle of muscle that surrounds the bladder opening. When you wish to pass urine, this ring of muscle relaxes, and the muscles in the wall of the bladder and around the abdominal cavity, contract to squirt the urine out in a steady stream. Those who are bed wetters, tend to sleep very deeply, and during the deepest phases of this sleep, when all the main muscles of the body are totally relaxed, the sphincter ring muscle that retains the urine in the bladder, also relaxes. Because there is no associated contraction of the muscles in the bladder wall or elsewhere, the urine just dribbles out slowly in the night, not in a hard stream.
Bed wetting is a common problem that may make businessmen dread overnight trips to a conference, cause marriages to break up, stop teenagers from spending the night at a friend's, and drive the mothers of some children to desperation.
Quiet, sensible toilet training at an appropriate age, that rewards success rather than punishing failure, may prevent the problem from developing. Some children are slower at controlling their bladder at night than others, and may be three or four years old before control is obtained.
The first step is to investigate the patient to exclude any cause for bed wetting. Chronic infections, structural abnormalities, and other rarer conditions may cause a weakness or excessive irritability of the bladder. Once these problems have been excluded by urine tests and x-rays, the treatment of a true bed wetter can begin.
Up to 10% of five year olds still wet the bed, so parents should not become too anxious until the child is past this age. Premature treatment can cause permanent sleep disturbances in a child, but delaying treatment beyond five can lead to the problem becoming a major influence in the child's life. The important thing to remember is that, in most cases, the problem can be controlled by cooperation between doctor, patient and family.
People with this problem are often too embarrassed to see their family doctor about the problem, but it may cause severe disruption to home life and a career. Adults should overcome any false embarrassment, and discuss the matter with their general practitioner to obtain confidential treatment. In children, the simple steps of restricting fluids for three hours before bedtime, taking the child to the toilet during the night, and establishing a reward system, can be tried. Unfortunately, these methods are often unsuccessful, and more specific remedies are required. The best form of treatment is the bed wetting alarm. This consists of a moisture sensitive pad that is placed under the patient, a battery and an alarm. When it becomes wet from the first small dribble of urine, it closes an electrical circuit, and sounds the alarm. The patient is then woken, and can empty the bladder in the toilet before returning to sleep. After a few weeks use, most people learn to waken before the alarm, and the problem is solved, but some patients require an extraordinarily loud alarm to wake them. Another effective form of treatment is the use of a medication (amitriptyline - see Medication Table) every night to alter the type of sleep. The muscles do not relax as much, thus retaining the urine in the bladder, and the patient can sleep quite normally. Over a few weeks, the dosage is slowly lowered, until the medication is stopped completely. Hopefully, the bad sleep habits and bed wetting do not return. The final form of treatment is psychotherapy by a psychiatrist, but this is used in only the most resistant cases.
Diet does not appear to be of any benefit.
Bed wetters are more likely to develop urinary infections. Social stigmatisation may become a major problem in some sufferers.
The vast majority of patients can control the problem before the teenage years, but in a small number, the problem may persist throughout life.