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Large-Scale Study Provides First-Ever Insights into the Genetic Causes of Bedwetting

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New evidence from the world’s first genome-wide association study (GWAS) identifies genes and genetic variants associated with bedwetting and may lead to earlier identification of children predisposed to bedwetting and improved earlier treatment options.The results are being presented by the International Children’s Continence Society (ICCS) and the European Society for Paediatric Urology (ESPU) on World Bedwetting Day on 29 May 2018.

“We have known for over a century, there has been strong evidence suggesting a genetic background for bedwetting.2 The risk of bedwetting is 5-7 times higher among children with a parent who suffered from bedwetting as a child, and approximately 11 times higher if both parents were bedwetters”,1 said Dr. Søren Rittig, Professor at the Department of Child and Youth, Nephro-urologic Team, Aarhus University Hospital who together with associate professor Jane Hvarregaard Christensen, Department of Biomedicine, Aarhus University is responsible for this new study.

Bedwetting is a common medical condition that has a serious impact on a child’s self-esteem, emotional well-being and day time functioning, including school and social performance3,4,5; and improvements in their working memory and other daily activities have been seen after treatment.6

The GWAS used the iPSYCH2012 nationwide population-based sample of around 80,000 Danish individuals collected to study among others ADHD and autism. Genome-wide association studies work by scanning markers across the entire genome of large numbers of people in order to find genetic variants associated with a particular disease.

Associate professor Jane Hvarregaard Christensen said, “By comparing the frequency of millions of genetic variants in thousands of DNA samples from bedwetting children we have been able to demonstrate specific genetic variants that each contribute to increase the risk of bedwetting. The genes implicated by this are known to function in deep brain areas responsible for regulation of day-night rhythms, urine production and sleep. This supports that bedwetting is linked to physiological mechanisms rather than being caused by psychological problems.” This is an important first step to provide new insights into the biological processes leading to bedwetting.

There are at least two main reasons why children are bedwetting – a reduced bladder capacity and/or an increased urine production during night-time (polyuria). By analyzing millions of genetic variants in bedwetting children, researchers were able to point to specific genes and thereby suggest specific biological causes of bedwetting.

Dr. Søren Rittig said, “We believe further research using the genes and genetic variants we have detected could help us identify bedwetting children earlier, determine which children would benefit from medication and tailor treatment to alleviate their condition.”

About Bedwetting

Bedwetting, also known as nocturnal enuresis, is an uncontrollable leakage of urine while asleep.7 In most cases it is caused by over-production of urine at night or reduced capacity of the bladder.4 An inability to wake up can be another cause.4 Bedwetting does not seem to have a psychological cause.4 Bedwetting is a common childhood medical condition, with approximately 5–10% of 7-year-olds regularly wetting their beds and the problem may persist into teenage and adulthood.8

About World Bedwetting Day

World Bedwetting Day was initiated to raise awareness among the public and healthcare professionals that bedwetting is a common medical condition that can and should be treated.

World Bedwetting Day 2018 will take place on 29 May and occurs on the last Tuesday of May each year. The theme is: ‘Time to Take Action’, in recognition that much more can be done to diagnose and treat those children who suffer from bedwetting.

For more information please visit www.worldbedwettingday.com.

About the World Bedwetting Day Steering Committee

The World Bedwetting Day Steering Committee brings together experts from across the globe to support this initiative and consists of the International Children’s Continence Society (ICCS), the European Society of Paediatric Urology (ESPU), the Asia Pacific Association of Paediatric Urology (APAPU), the International Paediatric Nephrology Association (IPNA), the European Society of Paediatric Nephrology (ESPN), the Sociedad Iberoamericana de Urologia Paediatrica (SIUP), and the North American Paediatric Urology Societies. The initiative is supported by Ferring Pharmaceuticals.

References

1 Jarvelin, M. R., Vikevainen-Tervonen, L., Moilanen, I. & Huttunen, N. P. Enuresis in seven-year-old children. Acta paediatrica Scandinavica 77, 148-153 (1988).
2 von Gontard, A., Schaumburg, H., Hollmann, E., Eiberg, H. & Rittig, S. The genetics of enuresis: a review. The Journal of urology 166, 2438-2443 (2001).
3 Iannelli V. Bedwetting. Available at https://www.verywell.com/bedwetting-bedwetting-statistics-2633257. Last accessed January 2017.
4 Vande Walle J et al, Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2012;171:971-98
5 Joinson C et al. A United Kingdom population-based study of intellectual capacities in children with and without soiling, daytime wetting, and bed-wetting Pediatrics. 2007;120(2):e308-16
6 Van Herzeele C, Dhondt K, Roels S P et al. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol. 2016; DOI 10.1007/s00467-016-23351-3
7 Austin P et al. The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children’s Continence Society, The Journal of Urology. 2014;191:1863-1865
8 Nevéus T. Nocturnal enuresis—theoretic background and practical guidelines. Pediatr Nephrol. 2011; 26:1207–1214

Contact information

Burson-Marsteller, on behalf of World Bedwetting Day Steering Committee
Jack Dixey, +44 (0)207 300 6221
Jack.Dixey@bm.com

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