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Urination - bed wetting

Definition

Nighttime urinary incontinence in children over age 5 or 6.

Alternative Names

Enuresis

Considerations

Bed wetting is divided into two categories. Primary nocturnal (nighttime) urinary incontinence is when a child has never achieved full bladder control (never been fully toilet trained). Secondary nocturnal urinary incontinence is when a child starts bed wetting again after having achieved bladder control.

Most children who haven't achieved bladder control 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

Primary bed wetting is usually simply due to a delay in the maturation of the part of the nervous system that controls bladder function. Secondary be wetting may be due to either psychological problems or medical disorders, such as a urinary tract infection, urinary tract abnormalities, or diabetes.

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 or pills. The latter stops bed wetting in 60-75% of children while taking the drug, but is not a permanent cure (once the medication is stopped, the bed wetting tends to come back).

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
  • What makes the problem worse?
  • Does the bed wetting increase in times of stress?
  • Is there a urinary tract infection present?
  • Do beverages consumed contain caffeine or alcohol?
• relieving factors
  • Is there anything that reduces the problem?
• other
  • What other symptoms are also present?
    • fever
    • abdominal pain
    • back pain
    • pain or burning when urinating
  • 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:

• urinalysis
• urine culture
• urodynamic studies

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:5/12/2006
Reviewed By:Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.

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