The Pediatric Enuresis Center at Shaare Zedek Medical Center operates as an integral part of the Pediatric Urology Department. Located on the second floor, the center is closely connected to the activities of the Pediatric Urology Institute and the Pediatric Urology Clinic.
The Center addresses common problems related to enuresis disorders (bedwetting) in children: nocturnal primary and secondary enuresis, as well as daytime voiding disorders (urgency, frequency, and daytime "dribbling" of urine and feces).
The center's multidisciplinary team includes pediatric urologists, pediatric gastroenterologists, child psychiatrists, a social worker, and two nurses who address any questions that arise during treatment and provide specialized biofeedback therapy for patients with voiding disorders.
Managing primary nocturnal enuresis
Primary nocturnal enuresis in children is a common issue, affecting around 14% of children at the age of 5. In most cases, the condition resolves spontaneously, with the prevalence decreasing to 7%-8% of 7-year olds and continuing to only about 2%-3% of adults. However, this usually transient condition can cause significant psychological distress for affected children.
Treatment is generally considered for children who wet the bed after the age of 5, when the neurological development of the urinary system is complete. Successful treatment depends on the child's willingness and readiness to participate in the treatment requirements. Since enuresis can have various underlying causes, treatment involves tailored approaches addressing these potential causes.
Main causes of nocturnal enuresis in children:
- The most common cause of primary nocturnal enuresis (80%-85% of cases) is related to relative daytime and nighttime urine production. Children with enuresis often produce similar amounts of urine during day and night, while those without the condition excrete around 80% of urine during the day and only 15-20% at night, allowing peaceful sleep without the need for nighttime awakenings to urinate.
- A further 15-20% of cases are caused by abnormal bladder behavior, whereby involuntary contractions of the bladder lead to urine leakage. Some of these children may also experience daytime symptoms including urgency and frequency of urination.
- In about 5% of cases, enuresis is linked to difficulties in waking up when the bladder is full. This isn't necessarily about deep sleep, but rather issues related to the waking process.
Since the most common cause concerns the balance of urine production between day and night, treatment often focuses on addressing this underlying issue. Desmopressin, a medication that mimics the action of vasopressin (the hormone responsible for regulating urine production), is a well-established and effective treatment for enuresis. It reduces nighttime urine output, allowing for dry nights.
If a child doesn't respond well to desmopressin or has a different underlying cause, alternative treatments might be considered, such as addressing bladder contractions or using a bedwetting alarm ("bell-and-pad").
Our comprehensive treatment approach has shown excellent results in managing enuresis. For questions or further clarification during treatment, feel free to contact our lead nurse at the Center for Pediatric Voiding Disorders at 02-6666968.
