Enuresis or Urinary Incontinence (Bedwetting )

What is urinary incontinence (enuresis)?

Urinary incontinence (enuresis) is the medical term for bedwetting. Incontinence is accidental or intentional urination in children who are at an age where they should be able to have control of their bladders. Girls usually obtain bladder control before boys. Incontinence may be diagnosed in girls older than age 5 and in boys who are older than age 6 who are still having urinary control problems. There are different types of bedwetting that may occur, including the following:

• Diurnal enuresis. Wetting during the day.

• Nocturnal enuresis. Wetting during the night.

• Primary enuresis. This occurs when the child has never fully mastered toilet training.

• Secondary enuresis. This occurs when the child did have a period of dryness, but then returned to having periods of incontinence.

What are some key facts about urinary incontinence (enuresis)?

According to the American Academy of Pediatrics: 

• Bedwetting affects 20 percent of 5-year-olds, 10 percent of 6-year-olds, and 3 percent of 12-year-olds.

• Nocturnal enuresis occurs two times more frequently in boys than in girls.

• Of the children with enuresis, most have wetting at night.

• Primary enuresis is the most common form of urinary incontinence among children.

What causes urinary incontinence?

There are many factors that may be involved, and many theories that are given for why children wet. The following is a list of some of the possible reasons for the problem:

• Poor toilet training

• Delay of the ability to hold urine (this may be a factor up to about the age of five)

• Small bladders

• Poor sleep habits or the presence of a sleep disorder

• A problem with the proper functioning of hormones that help to regulate urination

• Most children who wet the bed have at least one parent or a close relative who also suffered from bedwetting as a child

• Medication that affects sleep

How is urinary incontinence (enuresis) diagnosed?

Urinary incontinence (enuresis) is usually diagnosed based on a complete medical history and physical examination of your child. In addition to talking with you and the child, your child's doctor may perform the following to help rule out other causes for the wetting:

• Urine tests (to make sure there is not an underlying infection, or condition such as diabetes)

• Blood pressure measurement

• Blood tests

What is the treatment for urinary incontinence (enuresis)?

Specific treatment for enuresis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the condition

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Prior to starting treatment, it is important to know that:

• The child is not at fault and should not be punished. The child cannot control the wetting.

• According to the National Institute of Diabetes and Digestive and Kidney Diseases, after age 5 enuresis disappears naturally at a rate of about 15 percent of affected children each year.

Treatment may include:

• Positive reinforcement of the child (i.e., the use of sticker charts for dry nights)

• Use of night-time alarms to help tell the child when wetting is occurring

• Medications, as prescribed by your child's doctor (to help control the wetting)

• Bladder training to help increase the bladder size and the child's ability to know when they have to urinate (this is done by having the child wait as long as possible during the day to urinate and let the bladder get full)

• Decrease fluids (AAP suggests this approach if the child believes it helps) and avoid caffeine at night

In addition, counseling of the child and family may help to determine any stress the child may be under.