Enuresis (Bed-Wetting)

What is enuresis?

Enuresis (say "en-yur-ee-sis") is the medical term for bed-wetting during sleep. Bed-wetting is fairly common. About 5 million to 7 million children wet the bed. It's more common among boys than girls.

What causes bed-wetting?

Some of the causes of bed-wetting include the following:
Genetic factors (it tends to run in families)
Difficulties waking up from sleep
Slower than normal development of the central nervous system--this reduces the child's ability to stop the bladder from emptying at night
Hormonal factors (not enough antidiuretic hormone--this hormone reduces the amount of urine made by the kidneys)
Urinary tract infections
Abnormalities in the urethral valves in boys or in the ureter in girls or boys
Abnormalities in the spinal cord
Inability to hold urine for a long time because of small bladder
Bed-wetting isn't caused by drinking too much before bedtime. It's not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom. And children do not wet the bed on purpose or to irritate their parents.

When do most children achieve bladder control?

Children achieve bladder control at different ages. By the age of 5 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 5 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 5 is not necessary and may even be harmful to the child.

How can my family doctor help?

First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis). Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.The doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will ask about your family life, because treatment may depend on changes at home.

What are the treatments for bed-wetting?

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:
An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
A reward system for dry nights.
Asking your child to change the bed sheets when he or she wets.
Bladder training: having your child practice holding his or her urine for longer and longer times.

What kinds of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy hasn't worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects.

How can I help my child not feel so bad about wetting the bed?

Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty about something he or she can't control. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem.It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).