Bedwetting and ADHD

In the summer of 1995, Hans Eibert of the University of Copenhagen announced in the journal Nature Genetics that he had found the approximate location of the gene believed to be responsible for enuresis, or bedwetting, which affects about 8 percent of children past the age of seven.

Toddler Girl closing her eyes in the bed, perhaps she is seeing bad dreams.

Scientists have long known that this problem runs in families, so finding a gene is not a surprise. Unfortunately, ADHD tends to run in the same families to such an extent that doctors have been told to watch for a bedwetting child to develop symptoms of ADHD, and to be sensitive to the fact that children with ADHD may have problems with enuresis as well.

The Studies

The studies listed below are organized by date, with the most recent date first.  Some of the full texts will need a password because they are kept in a locked file to protect their copyright.  For educational purposes, we are allowed to share the password with you if you write to us.

If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.

Author Index
  1. Egger 1992
  2. Laurent 1987
  3. Miller 1993
  4. Oei 1989
  5. Ornitz 1999
  6. Pelikan 1999
  7. Robson 1997
  8. Salzman 1976
Pelikan 1999: Case study of 2 women with bladder problems
The role of allergy in interstitial cystitis, Pelikan Z, van Oers JA, Levens WJ, Fouchier SM, Nederlands Tijdschrift Voor Geneeskunde 1999 Jun 19;143(25):1289-92

 

 

 

 

“In two women, aged 47 and 58 years, who suffered from longstanding urinary bladder complaints, various urologic treatments … had had only a partial therapeutic effect. They also suffered from allergic rhinitis and multiple arthralgia. [joint pains]… The all-round allergologic management, including dietary measures, avoidance of the relevant allergens and nasal as well as oral administration of disodium cromoglycate therapy, led to the almost complete disappearance of the urinary and other complaints….” MedLine

Ornitz 1999: Study of boys with and without enuresis
Prepulse inhibition of startle and the neurobiology of primary nocturnal enuresis, Ornitz EM et al., Biological Psychiatry 1999 Jun 1;45(11):1455-66

 

 

 

 

“…This study evaluates the association of this PPI [prepulse inhibition] deficit in PNE [primary nocturnal enuresis, or bed wetting] with comorbidity with attention-deficit hyperactivity disorder (ADHD) and with intelligence. METHODS: Prepulse modulation of startle was studied in 96 boys with PNE and 105 nonenuretic boys using intervals of 60, 120, and 4000 msec between the onset of a 75-dB 1000-Hz tone and a 104-dB noise burst. … Those enuretic boys who also were ADHD or had higher performance IQs … showed the greatest PPI deficit. CONCLUSIONS: A common deficiency of inhibitory signal processing in the brain stem may underlie both deficient PPI and the inability to inhibit micturition [start of urination] in PNE.Note: As we have often seen from parent reports, when diet helps a child with ADHD who also wets the bed, it helps the bed wetting, too! MedLine

Robson 1997: Day & Night wetting and ADHD

Enuresis in children with attention-deficit hyperactivity disorder, Robson WL, Jackson HP, Blackhurst D, Leung AK, Southern Medical Journal 1997 May;90(5):503-5

“We did a retrospective study of the prevalence of nocturnal and diurnal enuresis in patients with attention-deficit hyperactivity disorder (ADHD)… Adjusting for differences in sex and current age, ADHD children at age 6 were 2.7 times more likely than controls to have nocturnal enuresis [bed wetting] and 4.5 times more likely to have diurnal enuresis. [daytime wetting]Nocturnal and diurnal enuresis was found to be significantly more common in children with ADHD than in control subjects. Physicians who treat patients with ADHD should routinely inquire about the presence of enuresis.
MedLine

Miller 1993: Discussion of non-drug treatments for bedwetting

Concomitant nonpharmacologic therapy in the treatment of primary nocturnal enuresis. Miller K, Clin Pediatr (Phila) 1993 Jul;Spec No:32-7

” Some 5 to 7 million children in the United States suffer from primary nocturnal enuresis (PNE). . . Several nonpharmacologic treatment modalities also are available, including bladder-stretching exercises, behavioral therapy, hypnotherapy, and elimination diets. . . .Although none of the methods offers effective resolution of nighttime incontinence in all children, combining methods increases the probability of treatment success and encourages compliance without risk to the child.

MedLine

Egger 1992: Double-blind study of diet on 21 children

Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7

“Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting] On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%]Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.

MedLine

Oei 1989: Case study of child with enuresis & encopresis
Enuresis and encopresis as a reaction to food, Oei HD, Pelikan-Filipek M, Pelikan Z, van Vliet AC, Ned Tijdschr Geneeskd 1989 Aug 5;133(31):1555-7 [in Dutch]

….”10-year old girl, suffering from diurnal and nocturnal enuresis [wetting] and encopresis [soiling]since she was a baby, had been repeatedly examined and treated by various medical specialists and a homeopathic doctor without any significant improvement … Finally her problem was solved after an allergological examination … She was put on a complete elimination diet, combined with oral disodium cromoglycate, and has been free of all complaints since 1 1/2 years.MedLine

Laurent 1987: Few-foods diet trial for kidney disease

Is adult idiopathic nephrotic syndrome food allergy? Value of oligoantigenic diets, Laurent J, Rostoker G, Robeva R, Bruneau C, Lagrue G, Nephron 1987;47(1):7-11

To evaluate the prevalence of food hypersensitivity in idiopathic nephrotic syndrome [a kidney disease] (INS), an oligoantigenic diet was given for 10 days to 13 patients with INS who had not steadily responded to corticosteroids; … At the end of the oligoantigenic diet, proteinuria was significantly reduced in the 13 patients as compared to the initial level. It decreased by more than 50% in 9 patients and disappeared completely in 5. It seems that an oligoantigenic diet is helpful in cases of INS that do not respond to corticosteroids. This argues for a role of food hypersensitivity in this disease and suggests that avoidance of specific foods on the longer term may be of benefit.This diet must be tried in INS before the initiation of immunosuppressive therapy.

MedLine

Salzman 1976: Clinical study on children

Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome, Salzman LK, Medical Journal of Australia 1976 Aug 14;2(7):248-51

Thirty-one children with behavioural problems and learning difficulties were allergy tested for sensitivity to salicylates, artificial colours and flavours, eighteen children had a positive response, and 15 of these were given the Australian Version of the Feingold K.P. diet. Ninety-three per cent [93%] responded with improved behaviour in the areas of overactivity, distractability, impulsiveness and excitability. Sleep and enuresis problems were resolved partially or completely. This study demonstrates that the aforementioned elimination diet significantly affects behaviour.

Note: Many people who don’t “test positive” on such tests still respond well to the diet. Allergy testing may be useful if positive, but does not rule out response to diet management if negative.

MedLine

The Diet Connection

The good news is that it is common for children to stop bedwetting once they begin the Feingold Program. Not all children are alike, of course – for some, accidental exposure to the eliminated additives results in bedwetting, while for others it seems that the salicylates are the irritant resulting in a wet bed or wet pants. For yet others, the culprit is milk.

While we have had many parent reports of the connection, there have unfortunately been only a few published studies connecting diet to enuresis.

In 1992, Egger published a study on children who suffered from either hyperactivity or migraine which had improved on a Feingold-type diet. Of the 21 children in that study who also had enuresis, 76% of them stopped or improved on the diet.

Jakobsson, in 1985, described a case of enuresis resulting from cow’s milk. Although, of course, the Feingold diet does not exclude cow’s milk, we do suggest considering it as a possible problem for those who do not respond to the diet alone.

This information is not intended to replace qualified medical care – it is always a good idea to ask your doctor to rule out bladder or kidney infections or other physical problems. Nevertheless, at the same time your children still have to eat – they might as well eat the best possible foods.