Bedwetting

Nighttime enuresis, or bedwetting, is usually defined as the involuntary loss of urine during sleep after the age of 5 years. It's known to cluster in family groups — if one or both parents have had trouble with bedwetting, their children are more likely to have similar problems. Bedwetting is also more common in boys.

Fifteen percent of 5-year-olds and 10 percent of 6-year-olds experience enuresis. As children mature, the number of children with enuresis problems declines at a rate of about 15 percent per year.

The cause of bedwetting is not known. Twenty to 30 years ago, psychological problems were thought to be the cause, but this is no longer believed to be the case in the overwhelming majority of children. And contrary to popular belief, research has shown that children with nighttime enuresis do not have abnormal sleep patterns.

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There are several theories, but most doctors think the difficulty lies with a developmental delay in the bladder. Just as some children walk and talk before others their age, bladder control may have wide variations, and these children simply need more time for their bladders to fully develop. The delayed development theory is supported by the fact that, for most children, bedwetting problems spontaneously disappear as they get older.

In some children, inadequate production of a hormone that decreases urine output during sleep may be the cause. This hormone, called antidiuretic hormone (ADH), occurs naturally in all of us and is responsible for concentrating urine if we become dehydrated. Secretion of this hormone is normally high at night.

It's unlikely that a physical cause is behind your child's bedwetting if your child:

A physical cause might be the culprit if your child:

  • Is wet day and night
  • Gets urinary tract infections
  • Has trouble with bowel control

If your child is wet during the day and night, it's important to rule out other causes of wetness, such as voiding dysfunction, infection, dysfunctional elimination syndrome and birth defects. For these children, a voiding diary, X-rays and lab tests may be recommended to determine if there's any underlying problem.

The treatment for bedwetting may consist of medication, conditioning and behavior modification, or a combination of approaches. Since bedwetting is very common until 6 years of age, we generally don't try to treat it earlier. At any age, decisions regarding treatment should consider to what extent the problem affects the child and the child's social development. Many young children and their parents are better served by reassurance that there's no physical abnormality than by long-term and expensive therapy of uncertain effectiveness.

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Your child's doctor can do a nighttime enuresis evaluation. During the visit, the doctor will ask about parental or sibling bedwetting, previous urinary tract problems, establishment of toilet training and daytime control.

The physical exam will include careful examination of the abdomen and genitalia, and a neurologic exam of the legs and perineum to determine sensation and adequate motor development. The lower back is inspected to check for abnormalities that might suggest abnormal development of the spinal cord.

If your child has a completely normal medical history and physical examination, and a normal urine test, further testing isn't needed.

Treating bedwetting isn't an exact science. Since it's very common until 6 years of age, we generally don't try to treat it earlier. At any age, decisions regarding treatment should consider to what extent the problem affects the child and the child's social development. Many young children and their parents are better served by reassurance that there's no physical abnormality than by long-term and expensive therapy of uncertain effectiveness.

Treatment may consist of medication, conditioning and behavior modification, or a combination of approaches.

Medication

There's no medication that cures enuresis — they only treat symptoms. When the drug is stopped, the enuresis will usually return unless the child has naturally outgrown it. Two commonly used drugs are Tofranil (imipramine) and DDAVP (desmopressin acetate).

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Reviewed by health care specialists at UCSF Benioff Children's Hospital.

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