Bedwetting, or enuresis, is the unintentional (involuntary) passage of urine into bed or clothes by children aged 4 years or older who have no physical problems.
Having nighttime control of urinating is the final stage of one process of development. Most children can control the bladder at night by age 3 years. Bedwetting is as common in boys as in girls until the age of 5. By age 11, boys who wet the bed outnumber girls by 2 to 1.
The cause is usually unknown. However, emotional problems caused by stress or separation, diabetes, urinary tract infections, family history of bedwetting, and being the firstborn child increase bedwetting risk. Also, stress may play a role in children who have bedwetting after being dry at night. This stress may be the birth of another child, hospitalizations, and head injury. Daytime wetting occurs more in girls than in boys and has more associated emotional problems.
The symptom is losing bladder control, usually in the bed at night, and sometimes during the day in an older child.
Because bedwetting may have medical causes, the health care provider will look for problems in the urinary tract (e.g., bladder), hormone secretion, sleep patterns, family history, and development of the child. The health care provider will do physical and mental status examinations, x-ray studies, and blood and urine tests to be sure that a physical reason is not the cause.
Most children with bedwetting never see the health care provider. Most families consider bedwetting part of normal childhood development and try to treat it at home. These attempts include restricting fluids (especially after dinner), and using rewards and punishments. Usually, punishing children makes bedwetting worse and may lead to self-esteem problems.
When initially treating bedwetting, the health care provider reassures the child that bedwetting can be treated. About 10% of children who have this first visit improve without treatment. Children with no emotional or medical problems will likely stop bedwetting on their own. Other treatments involve waking the child to urinate or having the child urinate before going to bed, avoiding liquids at bedtime, and rewards for dry nights. Medicines can also reduce urine output or affect the way the bladder works.
Psychosocial treatments include using a night alarm or a vibrating pad under the pillow. Relapse after successful treatment usually takes place within 6 months after treatment stops (about one third of children relapse).
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