What are the effects and signs?
Children are usually dry at night by 5 years. Because achieving dryness is variable and many children who are bedwetting at 5 and 6 will master control without medical intervention, diagnosis of nocturnal enuresis is not made until age 7. Age 7 is the earliest age that referral to enuresis clinic for specialist help can be made.
Enuresis is normal in young babies. Children learn to control their bladder and bowels during toilet training when they are 2 or 3 years old. Toilet training is a stepwise process that involves recognising the physical signals that the bladder or bowel is full and needs to be emptied. Once children can recognise these signs they can learn how to hold on or delay emptying them. Children are taught the cultural norms of how and where to go to the toilet during this period. Toilet training ends when a child routinely goes to the toilet appropriately in private. Faecal continence is usually learnt first followed by urinary continence. Daytime control is usually learnt before night time control. There will be a period during which a child is dry during the day but wears nappies at night. The age when dryness at night is achieved is variable and difficult to measure. The definition of bedwetting is variable, for example enuresis might be defined as wetting the bed at least twice a week in some studies and numbers will be small. In others the definition may be that the child is not reliably dry, consequently the enuresis group will include children who only occasionally wet the bed.
Nocturnal enuresis may be primary or secondary -:
- Primary nocturnal enuresis – means the child has never been satisfactorily dry at night – includes around 80% of children with nocturnal enuresis.
- Secondary nocturnal enuresis – means the child has had a period of at least 6 months of being dry at night – includes around 20% of children with nocturnal enuresis. This type of enuresis may be caused by a medical condition for example urinary tract infection or by emotional upset in which case it may be considered a form of behavioural regression.
