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Bedwetting


Definition:

Bedwetting is involuntary urination in children over 5 to 6 years old. It may occur at any time of the day or night. This article focuses on nighttime bedwetting.

See also: Incontinence

Alternative Names:

Enuresis

Symptoms:

The main symptom is involuntary urination, usually at night, that occurs at least twice per month.

Signs and tests:

Your child's doctor will discuss the history of bedwetting in detail. You can help by keeping a detailed diary that outlines normal urination and wetting episodes, fluid and food intake (including time of meals), and sleep times.

A physical examination should be performed to rule out physical causes. A urinalysis will be done to rule out infection or diabetes.

X-rays of the kidneys and bladders and other studies are not needed unless there is reason to suspect some other problems.

Treatment:

Doing nothing or punishing the child are both common responses to bedwetting. Neither helps. You should reassure your child that bedwetting is common and can be helped.

Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep. You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids excessively.

Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. While this is unlikely to solve the problem completely, it can help and should be tried before medicines are used. It is most useful in younger children, about 5 to 8 years old.

Bedwetting alarms are another method that can be used along with reward systems. The alarms are small and readily available without a prescription at many stores.

The alarm wakes the child or parent when the child starts to urinate, so the child can get up and use the bathroom. Alarm training can take several months to work properly. You may need to train your child more than once. Bedwetting alarms have a high success rate if used consistently.

Once your child is dry for 3 weeks, continue using the alarm for another 2 weeks and then stop.

A prescription medication called DDAVP (desmopressin) is available to treat bedwetting. It will decrease the amount of urine produced at night. DDAVP is easy to use and provides quick results. It can be used short-term for an important sleepover, or prescribed for long-term use for months. Your doctor may recommend stopping the medicine at different times to see if the bedwetting has gone away.

Tricyclic antidepressants (most often imipramine) can also help with bedwetting. However, side effects can be bothersome, and an overdose can be life-threatening. Therefore, these drugs are usually used when other treatments have failed.

Some sources find that bedwetting alarms combined with medicine results in the highest number of cures.

For children with secondary enuresis, your doctor will look for the cause of the bedwetting before recommending treatment.

Expectations (prognosis):

The condition poses no threat to the health of the child if there is no physical cause of bedwetting. The child may feel embarrassment or have a loss of self-esteem because of the problem. It is important to reassure the child. Most children respond to some type of treatment.

Complications:

Complications may develop if a physical cause of the disorder is overlooked. Psychosocial complications may arise if the problem is not dealt with effectively in a timely manner.

Calling your health care provider:

Be sure to mention bedwetting to your child's health care provider. Children should have a physical exam and a urine test to rule out urinary tract infection or other causes.

If your child is having pain with urination, fever, or blood in the urine, contact your child's doctor right away.

Prevention:

Getting plenty of sleep and going to the bathroom at regular times during the day and night can help prevent some aspects of bedwetting.

References:

Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360:1429-1436.

Katz ER, DeMaso DR. Rumination, pica, and elimination (enuresis, encopresis) disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.


Review Date: 8/2/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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