Definition

Bed-wetting is involuntary urination during sleep in children. Typically children become able to sleep through the night without wetting around ages 3 to 5 years. Talk to your doctor if your child has bed-wetting after age 5 years. There are two types bed-wetting (also called enuresis):

• Primary nocturnal enuresis (PNE)—no periods of nighttime dryness
• Secondary nocturnal enuresis (SNE)—periods of nighttime dryness longer than 6 months followed by bed-wetting

Bed-wetting is common and not related to a medical condition. Most will stop by the time the child reaches puberty. However, bed-wetting remains a problem for up to 1% of adults.

Urinary System in Child

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Causes

Some bed-wetting may be caused by infections or abnormalities of the urinary system. Most bed-wetting has no explanation.

Some factors that may contribute to bed-wetting include:

• Bladder control that develops more slowly than normal
• Greater than average urine production at night
• A sleep disorder, sometimes related to enlarged tonsils or adenoids
• A tendency for deep sleep

In rare cases, bed-wetting may be a symptom of a health condition. These conditions may cause excess urine or prevent the bladder from completely emptying. They include :

• Kidney or bladder infections
• Kidney disease
• Diabetes mellitus
• Diabetes insipidus (a very rare disorder in which sugar is normal but excess water is excreted by the kidney)
• Congenital bladder, kidney, or neurological abnormality

Risk Factors

Factors that increase the chance of bed-wetting include:

• Family members with a history of bed-wetting
• Significant psychosocial stressors, such as:
  • Moving to a new home
  • Loss of a loved one
  • A new baby in the home
  • Initial toilet training that was too stressful
  • Physical or sexual abuse
• Chronic constipation

Symptoms

The child wakes up and finds the bed wet from urine.

Diagnosis

The doctor will ask about symptoms and medical history. A physical exam will be done. Your doctor will ask about:

• Family history of bed-wetting
• Daytime urinary patterns
• Problems urinating, such as pain or weak stream
• Usual intake of fluids
• Type of fluids consumed
• Presence of blood in the urine
• Strained family dynamics around the issue of bed-wetting
• Child's emotional response to the behavior
• Recent psychological trauma

Your doctor may order tests to look for infections or structural problems:

• Urine sample—to check for infections and other problems with the urinary tract
• X-rays or ultrasound —if a physical abnormalities is suspected

If an underlying problem in the urinary tract is suspected, your child may be referred to a specialist.

Treatment

Most treatment aims to gradually reduce the number of bed-wettings until the child grows out of it. Treatment is rarely appropriate before age six. Bed-wetting does not interfere with social development until after age 6 years.

If your child's bed-wetting is caused by an infection or physical abnormality, your doctor will create a treatment plan for that issue.

Prevention

Excess intake of fluid is rarely the cause of bed-wetting. Restricting fluids prior to bed does not help all the time. Still, it is reasonable to have all children empty their bladders prior to bed. Some parents wake their children every few hours to urinate, but most report that they rarely get much cooperation.