Bedwetting causes

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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Steven C. Campbell, M.D., Ph.D., [2] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic.

Causes

Only a small percentage of bedwetting is caused by an infection, physical abnormality, or other specifically identifiable cause.

Neurological-Developmental

Most bedwetting is caused by neurological-developmental problems involving multiple factors. Most bedwetting children are simply delayed in developing the ability to stay dry and have no other developmental issues. When there are other neurological-developmental issues, these can range from mild to severe.[3]

Infection/Disease

Less than 5% of all bedwetting cases are caused by infection or disease, the most common of which is a urinary tract infection. Infections and disease are more strongly connected to secondary nocturnal enuresis and with daytime wetting.[4]

Genetics

Bedwetting has a strong genetic component. Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.[5] Genetic research shows that bedwetting is associated with the genes 13q and 12q (possibly 5 and 22 also). [6]

Physical Abnormalities

Less than 10% of enuretics have urinary tract abnormalities, such as a smaller than normal bladder. Current data does support increased bladder tone in some enuretics, which functionally would decrease bladder capacity.[7]

Insufficient Anti-diuretic hormone (ADH) Production

A portion of bedwetting children do not produce enough of the Anti-Diuretic Hormone. Normally ADH increases at night. This increase doesn't occur in child enuretics, but does occur in adolescent enuretics. The diurnal change may not be seen until ~age 10. [8]

Stress

Stress is controversial as a possible cause of bedwetting. Some sources report that, “Psychologists and other mental health professionals regularly report that children begin wetting the bed during times of conflict at home or school. Dramatic changes in home and family life also appear to lead some children to wet the bed. Moving to a new town, parent conflict or divorce, arrival of a new baby, or loss of a loved one or pet can cause insecurity that contributes to bedwetting.”[9]
Other sources contradict this, saying, “Doctors have found no relationship to social background, life stresses, family constellation, or number of residencies.” [10]

Psychological

In rare cases, bedwetting is a symptom of a more severe underlying psychological problem. Medical guidance for doctors state that this is a relatively rare occurrence.[11] [12] When Enuresis is caused by a psychological disorder, the bedwetting is considered a symptom of the disorder. Enuresis does have a psychological diagnosis code (see previous), but it is not considered a psychological problem itself.[13] (See section on psychological/social impact, below)

Caffeine

Caffeine increases urine production. [14]

Food Allergies

For some patients, food allergies may be part of the cause. This link is not well established, requiring further research. [15][16]

Sleep Disorders

Sleep issues are another controversial potential cause of bedwetting.

  • Sleep apnea stemming from upper airway obstruction has been associated with enuresis. This can be signaled by snoring and enlarged tonsils or adenoids [17]
  • Many parents report that their bedwetting children are heavy sleepers. Research in this has some contradictory results. Studies show that children wet the bed during all phases of sleep, not just the deepest (stage four). A recent study, however, showed that enuretic children were harder to wake [18] Some literature does show a possible connection between sleep disorders and ADH production. Insufficient ADH might make it more difficult to transition from light sleep to being awake. [19]

Constipation

Chronic constipation can cause bedwetting. When the bowels are full, it can put pressure on the bladder. [20]

Attention Deficit Hyperactivity Disorder (ADHD)

Children with ADHD are 2.7 time more likely to have bedwetting issues. [21]

Improper Toilet Training

This is another disputed cause of bedwetting. This theory was more widely supported in the last century and is still cited by some authors today. Some say bedwetting can be caused by toilet training that is started too early or is too forceful. Recent research has shown more mixed results and a connection to toilet training has not been proved or disproved.[22]

Dandelions

Anecdotal reports and folk wisdom says children who handle dandelions can end up wetting the bed.Dandelions are reputed to be a potent diuretic.[1] English folknames for the plant are "peebeds" and "pissabeds".[2] In French dandelions are called pissenlit, which means "urinate in bed"; likewise "piscialletto", an Italian folkname, and "meacamas" in Spanish.[3]

References

  1. "Dandelions:time to throw in the trowel". Retrieved 2007-07-10.
  2. "English folklore".
  3. "Benefits of herbal tea".



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