National Sleep Foundation

Chapter 6: Parasomnias

Etiology and Risk Factors for Enuresis (Bedwetting)

What are the etiology and the risk factors for bedwetting (enuresis)?

Genetic and familial factors contribute to enuresis.1-3      

The child may have a small bladder, or may not have developed the muscle control necessary to control the bladder. Anatomic bladder problems have been suggested as a cause of enuresis, but such abnormalities have been found to account for only 2 – 4 percent of cases.4

In addition, enuresis is associated with psychological stressors;5 Attention Deficit and Hyperactivity Disorder (ADHD);6-7 and medical problems, such as urinary tract infections or diabetes.

Other sleep disorders can be associated with enuresis; studies suggest that Obstructed Sleep Apnea Syndrome (OSAS) is present in about half of children who are persistent bed-wetters.8
Enuresis may be the sole manifestation of nocturnal seizures.9

Another hypothesis involves the production of an antidiuretic hormone called “arginine vasopressin.” Production of this hormone follows a circadian pattern, with the hormone levels rising at night and reducing the production of urine. Studies suggest that children with enuresis are delayed in developing this nocturnal rise, and that the resulting polyuria overwhelms the ability of the bladder to retain urine.10

References

  1. Hublin C, Kaprio J, Partinen M, Koskenvuo M: Nocturnal enuresis in a nationwide twin cohort. Sleep. 1998;21:579-585.
  2. Ozkan KU, Garipardic M, Toktamis A, Karabiber H, Sahinkanat T. Enuresis prevalence and accompanying factors in schoolchildren: a questionnaire study from southeast Anatolia. Urol Int. 2004;73:149-155.
  3. Koff SA. Enuresis. In: Walsh PC, Retik AB, Vaughan ED et al (eds): Campbell's urology, 7th ed. Philadelphia: WB Saunders, 1998;2055-2068.
  4. Mahowald MW, “Other Parasomnias,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 1198-1105.
  5. Baeyens D, Roeyers H, Vande Walle J, Hoebeke P. Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review. Eur J Pediatr. 2005;164:665-672.
  6. Touchette E, Petit D, Paquet J, et al. Factors associated with fragmented sleep at night across early childhood. Arch Pediatr Adolesc Med. 2005;159:242-249.
  7. Brooks LJ, Topol HI. Enuresis in children with sleep apnea. J Pediatr. 2003;142:515-518.
  8. Nielson T, Zadra A, “Idiopathic Nightmares and Dream Disturbances Associated with Sleep-Wake Transitions,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 1106-1115.
  9. Thiedke CC. Nocturnal enuresis. Am Fam Physician. 2003;67:1499-1506.
  10. Mahowald MW, “Other Parasomnias,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 1198-1105.