Bedwetting

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.

See also: Incontinence

Alternative Names

Enuresis

Causes, incidence, and risk factors

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.

Bedwetting is common. More than 5 million children in the U.S. wet the bed at night. Some children 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.

Bedwetting runs strongly in families.

There are two types of bedwetting

• Primary enuresis: Children who have never been consistently dry at night. 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.
• Secondary enuresis: Children who were dry for at least 6 months start bedwetting again. 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.

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

Symptoms

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

Signs 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 or 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.

Bedwetting alarms are another method that can be used along with reward systems. The alarms are small and readily available without a prescription at many stores.

The alarm wakes the child or parent when the child starts to urinate, so the child can get up and use the bathroom. Alarm training can take several months to work properly. You may need to train your child more than once. Bedwetting alarms have a high success rate if used consistently.

Once your child is dry for 3 weeks, continue using the alarm for another 2 weeks and then stop.

A prescription medication called DDAVP (desmopressin) is available to treat bedwetting. It will decrease the amount of urine produced at night. DDAVP is easy to use and provides quick results. It can be used short-term for an important sleepover, or prescribed for long-term use for months. Your doctor may recommend stopping the medicine at different times to see if the bedwetting has gone away.

Tricyclic antidepressants (most often imipramine) can also help with bedwetting. However, side effects can be bothersome, and an overdose can be life-threatening. Therefore, these drugs are usually used when other treatments have failed.

Some sources find that bedwetting alarms combined with medicine results in the highest number of cures.

For children with secondary enuresis, your doctor will look for the cause of the bedwetting before recommending treatment.

Support Groups

Expectations (prognosis)

The condition poses no threat to the health of the child if there is no physical cause of bedwetting. The child may feel embarrassment or have a loss of self-esteem because of the problem. It is important to reassure the child. Most children respond to some type of treatment.

Complications

Complications may develop if a physical cause of the disorder is overlooked. Psychosocial complications may arise if the problem is not dealt with effectively in a timely manner.

Calling your health care provider

Be sure to mention bedwetting to your child's health care provider. Children should have a physical exam and a urine test to rule out urinary tract infection or other causes.

If your child is having pain with urination, fever, or blood in the urine, contact your child's doctor right away.

Prevention

Getting plenty of sleep and going to the bathroom at regular times during the day and night can help prevent some aspects of bedwetting.

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References

Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360:1429-1436.

Katz ER, DeMaso DR. Rumination, pica, and elimination (enuresis, encopresis) disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.