Incontinence

Bed Wetting (nocturnal enuresis)

Signs and Symptoms
Diagnosis
Treatment

Signs and Symptoms

Nighttime enuresis is usually defined as the involuntary loss of urine during sleep after the age of 5 years. It is known to cluster in family groups. If one or both parents have had trouble with bedwetting, their children have an increased chance of having similar problems. It is more common in boys.

Fifteen percent of 5-year-olds and 10 percent of 6-year-olds experience enuresis. As children mature, there is a gradual reduction in the number of children who are wet at a rate of about 15 percent per year.

We don't know what causes bedwetting. Twenty to 30 years ago, psychological problems were thought to be the cause, but this is no longer believed to be the case in the overwhelming majority of children.

There are several theories. Most physicians think the difficulty lies with a developmental delay in the bladder. These children simply need more time for their bladders to fully develop. Just as some children walk and talk before others their age, bladder control may have wide variations. The delayed development theory is most bedwetting spontaneously disappears as children get older.

In some children, inadequate production of a hormone that decreases urine output during sleep may be the cause. This hormone, called antidiuretic hormone (ADH), occurs naturally in all of us and is responsible for concentrating urine if we become dehydrated. This hormone is not related to sex hormones. Secretion of this hormone is normally high at night.

Contrary to popular belief, research has shown that children with enuresis do not have abnormal sleep patterns.

A physical cause for enuresis is unusual in those children who:

• Wet only during sleep
• Have never had a urinary tract infection
• Urinate normally during the day

A physical cause for enuresis might be present in children who:

• Wet day and night
• Have urinary tract infections
• Have trouble with bowel control

However, if the child is wet during the day and night, it important to rule out other causes of wetness, such as voiding dysfunction, infection, dysfunctional elimination syndrome and congenital anomalies. For these children, a voiding diary, X-rays and/or lab tests may be recommended to determine if there is any underlying acquired or anatomic problem.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007