Is nocturia a pathology?

Nocturnal enuresis is the most common urinary incontinence in children. It is defined as the infant's inability to hold urine during the night despite having gone to the bathroom before bedtime. Nocturia affects a lot of school-age children and even some teenagers. This is not a serious health problem. However, nocturia can be uncomfortable for children, parents, and family members.


1. Is nocturnal enuresis common in adolescents and young adults?

About 20% of children have some problem with nocturia by age 5 and up to 10% still have by age 7. By adolescence, this rate is estimated to be between 1% and 3% of children. Nocturnal enuresis is 2 to 3 times more common in boys than in girls.

2. Types of nocturia

2 types:

  • Primary: a situation in which the child has never controlled his bladder at night and always wets the bed.
  • Secondary: a child has had nocturnal bladder control for a period of at least 6 months. However, for some reason, the child lost that control and now wets the bed again.

Primary nocturia is much more common. Secondary nocturia in older children or adolescents should be evaluated by a doctor. Symptoms that occur in this age group can be a sign of a urinary tract infection or other health problems such as nerve problems related to the brain, stress, etc.

Is nocturia a pathology?

Nocturia occurs in many children

3. Some reasons

The exact cause of this condition has not yet been determined. It is thought to appear due to a delay in development in at least one of the following three organs at night:

  • Bladder: less space in the bladder at night.
  • Kidneys: more urine is produced at night.
  • Brain: unable to wake up during sleep.

In infants and toddlers, the connections between the brain and the bladder are not fully formed. The bladder will release urine whenever it feels full. As children get older, connections between the brain and urinary tract system develop more. This allows a child to have control over emptying the bladder. This control usually develops during the day before. It took longer before it happened at night.

4. Other causes of nocturia

4.1. Genetic

If one parent wets the bed after the age of 5, 40% of their children may have the same problem. If both parents wet the bed as babies, each of their children has about a 70% chance of having the same problem.

4.2. Stress

This is one of the most common reasons for secondary nocturia. Children can experience stress when moving to a new home/school or when they go through a parent's divorce or loss of a parent. This stress can cause nocturnal enuresis. Treating stress can prevent this problem.

Is nocturia a pathology?

Stress can also lead to this condition

4.3. Deep sleep

Deep sleep can be part of normal adolescent development. This is common during puberty and especially during the high school years.

4.4. Sleep apnea or snoring due to airway obstruction

In rare cases, bedwetting occurs because the child has sleep apnea or snores. Children with partially blocked airways may stop breathing momentarily during sleep. This can change the brain's chemical balance and trigger nocturia.

4.5. Constipation

The bladder and intestines are located very close to each other in the body. If the bowel is constipated, it will bulge, which can push into the bladder and cause the child to lose bladder control. Treating constipation is often the first step to treating nocturnal enuresis in these cases. If your child has pain or muscle tension during bowel movements, this could be contributing to nocturia.

Is nocturia a pathology?

Constipation in children

4.5. Bladder or kidney disease

This may be the case if a child has both daytime and nighttime bladder control problems. Other urinary symptoms such as pain while urinating or needing to urinate frequently will appear. Cystitis and urinary tract infections, neurogenic bladder, and urethral obstruction may be reasons for needing treatment.

4.6. Neuropathy

Sometimes a problem with the development of the spinal cord in childhood can cause bedwetting. If your child has other symptoms such as numbness, tingling, or pain in the legs, a spine problem may be considered. However, this is a very rare cause.

4.7. Other diseases

In rare cases, many other conditions such as diabetes also cause nocturia in children. Diabetes insipidus is also a cause for screening. Some studies show that children with attention deficit/hyperactivity disorder are more likely to have bedwetting. This problem may be due to differences in the brain's chemical pathways. Certain medications can also increase the risk of nocturia.

5. Emotional impact of nocturnal enuresis

Nocturia can have a significant emotional impact on children and families. Children may be embarrassed, feel anxious, and lack confidence. This affects their relationships, quality of life and schooling.

Children with nocturnal enuresis may feel unable to go to bed with friends or camp overnight. Siblings and parents may have to sleep in separate rooms or be woken up by bedwetting. Family members have the extra job of washing their sheets and clothes.

It's important to remember that nocturia is not your child's fault. Family members should not scold or punish the child. Instead, see your doctor to find out the cause and take steps to help your child.

Is nocturia a pathology?

Nocturia has a negative impact on children's psyche, so parents need to encourage their children

6. How will the doctor evaluate nocturnal enuresis?

The doctor will first ask about any other urinary tract symptoms in your child, such as:

  • Does your child want to pee a lot?
  • Need to run to the toilet a lot?
  • Pain or burning when urinating?
  • How is your child's sleep?
  • Urinary frequency and their health.
  • Did parents wet the bed at night as a child?
  • Stressful events in the child's life.

Your child will also get a full physical exam including:

  • Urine test: shows signs of certain disease or infection.
  • Blood tests are not usually needed.
  • Plain abdominal radiograph to rule out constipation.
  • Ultrasound of the bladder and kidneys, both before and after bladder emptying.
  • Magnetic resonance imaging (MRI) of the spine if your child has an abnormal neurological exam of the lower extremities. Can detect lumbar spine defect.
  • Study urodynamics and cystoscopy if the patient has urethral obstruction or neurogenic bladder or dysfunction that does not improve after 3 months of treatment.

Is nocturia a pathology?

Necessary tests will be conducted

7. Should nocturia be treated for older children and adolescents?

Treatment for nocturnal enuresis first depends on whether it is caused by stress. 

Only two drugs have been approved to treat bedwetting: Imipramine and Desmopressin. It is important to note that bedwetting usually returns after stopping the medication, unless the child has matured in controlling nocturia.

  • Imipramine works well in some children with nocturnal enuresis. There are several reported cases of overdose of this drug. Therefore, it is important for parents to closely control how and when they give their children medicine.
  • Desmopressin helps reduce the amount of urine the body makes, improving bedwetting in about 40% to 60% of children. Desmopressin comes in both nasal spray and pill form, which is taken at bedtime. Do not drink any liquid after taking the medicine to reduce the risk of electrolyte imbalance. In patients who do not respond to desmopressin alone, an additional drug such as Oxybutynin may be used in combination. 

Is nocturia a pathology?

Children can use medicine to treat

8. Advice for parents of children with nocturia

  • Limit your child's intake of foods or beverages with caffeine. Avoid salty, sugary foods and drinks, especially in the evening.
  • Encourage your child to go to the bathroom regularly during the day (every 2-3 hours) and right before bedtime.
  • Wake your child once during the night to urinate, if necessary. Waking your baby more than once a night can disrupt sleep. This can lead to problems at school the next day.

>> See more: Methods to help children improve bedwetting.

9. Does nocturnal enuresis happen to my child in adulthood?

Bedwetting almost always goes away on its own. Most children will have this problem under control by the late teen years or earlier. Secondary nocturia may go away once the cause is found. If nocturia doesn't stop in the late teen years, your child should see a doctor.

In summary, nocturia is a common symptom in children. This is the result of the normal physiological development of the child. However, if the condition appears when the child is over 5 years old, it may signal a medical problem in the body. You should take your child to see a doctor to find out the cause and have appropriate solutions. 

Doctor Hoang Thi Viet Trinh

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