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Understanding the underlying causes of nocturnal enuresis

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Many children experience bedwetting at some point in their life

Nocturnal enuresis, or bedwetting, is now a recognised medical condition from the age of five years, but it was long thought to be no more than a common childhood condition that most children grow out of. It was never given high clinical priority and, as a result, treatment was often not started until a child was aged over seven years, despite guidance from the National Institute for Health and Care Excellence to begin treatment from five years.1

Emerging research shows that bedwetting is not the benign condition we once thought, and delaying assessment and treatment can have a serious impact on the child’s health and wellbeing.

This article reviews the recent research on bedwetting and discusses possible optimisation of treating this common condition.

Causes of bedwetting

Historically, bedwetting was considered a single disorder with psychiatric undertones, and it is only recently that we have gained a greater understanding of the pathogenesis.

Nocturnal enuresis is now known to be a more complex medical condition involving many factors. This includes the volume of urine produced at night, the ability of the bladder to store it and the child’s poor sleep arousal to signals that the bladder is full.

Genetics is known to play a part, and a significant number of children also have underlying constipation, which neither they nor their family may recognise or be aware of.

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