Bedwetting

Alternative Names

Enuresis

Definition

Bedwetting is involuntary urination in children over 5 to 6 years old. It may occur at any time of the day or night. This article focuses on nighttime bedwetting.

Causes

Children develop complete control over their bladders at different ages. Nighttime dryness is usually the last stage of toilet learning. When children wet the bed more than twice per month after age 5 or 6, it is called bedwetting or nocturnal enuresis.

Children who were dry for at least 6 months and then started wetting again have secondary enuresis. There are many reasons that children wet the bed after being fully toilet trained. It might be physical, emotional, or just a change in sleep.

Children who have never been consistently dry at night have primary enuresis. This usually occurs when the body makes more urine overnight than the bladder can hold and the child does not wake up when the bladder is full. The child's brain has not learned to respond to the signal that the bladder is full. It is not the child's or the parent's fault.

Physical causes are rare, but may include lower spinal cord lesions, congenital malformations of the genitourinary tract, infections of the urinary tract, or diabetes.

Bedwetting runs strongly in families. More than 5 million children in the U.S. wet the bed.

About 9% of boys and 6% of girls still wet the bed at age 7. The numbers drop slightly by age 10. Although the problem goes away over time, many children and even a small number of adults continue to have bedwetting episodes.

Symptoms

The main symptom is involuntary urination, usually at night, that occurs at least twice per month.

Exams and Tests

Your child's doctor will discuss the history of bedwetting in detail. You can help by keeping a detailed diary that outlines normal urination and wetting episodes, fluid and food intake (including time of meals), and sleep times.

A physical examination should be performed to rule out physical causes. A urinalysis will be done to rule out infection or diabetes.

X-rays of the kidneys and bladders and other studies are not needed unless there is reason to suspect some other problems.

Treatment

Doing nothing or punishing the child are both common responses to bedwetting. Neither helps. You should reassure your child that bedwetting is common and can be helped.

Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep. You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids excessively.

Reward your child for dry nights. Some families use a chart of diary that the child can mark each morning. While this is unlikely to solve the problem completely, it can help and should be tried before medicines are used. It is most useful in younger children, about 5 to 8 years old.