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Bedwetting (Nocturnal Enuresis)

Bedwetting (Nocturnal Enuresis)

Programs that treat this condition

	Center for Pediatric Sleep Disorders		Neurourology Program
	Voiding Improvement Program		Center for General Pediatric Urology
	Developmental Medicine Center

What is nocturnal enuresis?

Any parent who has potty-trained a child knows that nighttime bedwetting is the last hurdle to clear before you can declare complete victory over diapers. In fact some children don't attain night-time control for several years after they have complete control during the day. Nocturnal enuresis, more commonly known as bedwetting, occurs when a sleeping child cannot control his or her urinating at night. But nighttime wetting is not considered abnormal prior to 5 years of age. And even then, there is usually no cause for alarm because most of the time the situation resolves on its own.

Do many children experience nocturnal enuresis?

If your child is five years old and still wetting the bed at night you are not alone. Enuresis occurs in 15 to 20 percent of all 5-year-old children, 10 percent in 7-year-olds. Therefore, an estimated five to six million children are affected by bedwetting at the age of 5. Approximately 15 percent of these cases will resolve on their own in each subsequent year so that only one to two percent of adolescents (age 15) still wet at night. Twenty percent of children with this problem have some element of daytime wetting.

What causes nocturnal enuresis?

Bedwetting is not a behavioral problem and may not be related to how a child sleeps. Many parents have the perception that their children are very 'deep' sleepers and this is what has caused the bedwetting. However, studies have shown no difference in the sleep patterns of enuretic and normal children. There is more evidence suggesting that enuresis is the result of a developmental delay in the normal process of achieving nighttime control. The normal process involves the release of a hormone that prompts the kidneys to slow down production of urine during nighttime sleep. This hormone, called vasopressin, is not secreted in many children who have a problem at night usually.

There is no single cause for this condition but researchers have discovered some genetic links, suggesting heredity may play a role.

How is nocturnal enuresis diagnosed?

If your child is 6 years of age or older, it is a good idea to set up a consultation with a pediatric urologist. This can be important to help tailor therapy or ensure that there are no other problems which may be contributing or causing the nighttime wetting such as bladder instability or posterior urethral valves. It has been estimated that between 18 and 39 percent of children have symptoms of bladder instability. For this reason, a careful history of your child's complete voiding habits and bowel habits will be important. Additional studies may sometimes be necessary and can include:

renal bladder ultrasound - a non-invasive test in which a transducer is passed over the kidney and bladder producing sound waves which bounce off these organs, transmitting pictures of them on a video screen. The test is used to determine the size and shape of the kidney and bladder, and to detect a mass, stone, cyst, or other obstruction or abnormalities.
voiding cystourethrogram (VCUG) - a specific x-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
urodynamics - The urodynamics study is a test used to assess how the bladder and urethral sphincter function in accordance with the brain and spinal cord during the stages of bladder filling and emptying.

The necessity of these studies will be determined by your pediatric urologist as your child is evaluated.

Treatment Options

Because there are several theories regarding the cause nighttime wetting, there are a variety of therapies available based on the premise of each of these theories. However, no one theory has proven correct nor has one treatment proven 100% successful. Often a combination of therapies is used in the hopes of gaining nighttime control.

However, keep in mind that in most cases, the condition is self-limited and resolves spontaneously without specific treatment. Bed-wetting is not harmful to your child in any way other than its impact on self-esteem. If your child is embarrassed to attend camp or a sleepover, you may want to talk with your pediatric urologist about therapies that include behavior modification (i.e. restriction of fluids after 6 pm), conditioning therapy (enuretic alarm), drug therapy that includes DDAVP, which replaces the natural hormone vasopressin, and psychotherapy. Your pediatrician urologist will discuss with you a combination that works for you and your child, keeping in mind that the burden of therapy shouldn't outweigh the burden of the condition itself.


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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