Female urinary tract
Female urinary tract
Male urinary tract
Male urinary tract

Urination - bed wetting

Definition:
Nighttime urinary incontinence in children over age 5 or 6.

Alternative Names:
Enuresis

Considerations:

Most children who wet the bed have at least one parent or first degree relative who also had a problem with bed wetting. Knowing this often helps the child feel less stressed about the situation.

Roughly 20% of children still wet their beds at age 5, only 5% do so by age 10, and 2% by age 15. Only 1 out of 100 childhood bed wetters continues to have a problem in adulthood.

Common Causes:

Bed wetting is usually simply due to a delay in the maturation of the part of the nervous system that controls bladder function. It sometimes may be due to either psychological problems or medical disorders, such as a urinary tract infection, urinary tract abnormalities, or diabetes (diabetes mellitus or diabetes insipidus).

Home Care:

Do not worry about bed wetting in children before the age of 6, unless they were previously well toilet trained and the bed wetting is now a new symptom.

Do not punish a child who wets. This problem is not caused by laziness or rebelliousness. Shaming a child for wetting the bed can lead to poor self-esteem and feelings of low self-worth.

Reassure, encourage, and express confidence in the child.You can also have your child take an active part in cleaning up from the bed wetting (e.g., help with stripping the bed, putting the sheets in the laundry, etc.)

Withholding bedtime drinks may be helpful in some children because it decreases the volume of urine in the bladder, but this does not prevent the problem completely. Avoiding caffeine-containing drinks can also help decrease the amount of urine in the bladder (caffeine increases urine production).

See your health care provider to consider the use of alarm systems (such as Wet-stop or Enuretone), or drugs like DDAVP nasal spray. The latter stops enuresis in 60-75% of children while taking the drug, but is not a permanent cure (once the medication is stopped, the bedwetting tends to recur).

Call your health care provider if:
Call your doctor if there have been repeated episodes of bed wetting after the age of 6, if your child complains that it hurts when he/she urinates, if your child has been drinking excessive amounts of fluids, or if your child has been exhibiting strange behavioral changes (such as a normally outgoing child becoming withdrawn or a child suddenly behaving in a sexually suggestive manner).
What to expect at your health care provider's office:

A medical history will be obtained from the patient and the patient's parents (if the patient is a child).

Medical history questions documenting the bed wetting in detail may include:

  • time pattern
    • When did bed wetting begin?
    • How often does bed wetting occur?
    • Have there ever been "dry" periods before?
  • quality
    • How often is daytime urination?
    • Is control of urine while awake a problem?
    • Does bed wetting cause awakening?
    • How is the bed wetting treated within the family?
    • Is the bed wetting punished?
    • Are other family members aware of the problem?
    • Does the bed wetting cause shame?
  • aggravating factors
  • relieving factors
    • Is there anything that reduces the problem?
  • other
    • What other symptoms are also present?
    • What medications are being taken?
    • Have other family members had this problem?
    • Is there a family history of diabetes?
    • Is bowel control a problem?
    • Is sensation of the need to urinate present?
    • What methods of prevention have been tried?
      • rewards
      • diapers
      • alarm systems
      • periodic waking
      • restricting fluids

A complete examination will be performed, with emphasis on the abdomen, rectum, and the urinary opening. The health care provider will discuss the options available for treatment.

Diagnostic tests that may be performed include:

After seeing your health care provider:
If a diagnosis was made by your health care provider related to bed wetting, you may want to note that diagnosis in your personal medical record.


Review Date: 5/21/2002
Reviewed By: Elizabeth Hait, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.