Enuresis (urinary incontinence)

  • Enuresis is the medical term for involuntary urination or “wetting.” Other words for this problem include incontinence, voiding problems or urinary accidents. Most children have control of their bladders by age 4 for daytime control and by age 6 for nighttime control, but up to 20 percent of first-grade boys, 6 to 7, and 17 percent of first-grade girls have problems with wetting accidents.

    • Enuresis can occur at night (nocturnal enuresis or bedwetting) or during the day (diurnal enuresis).

    • There is no single cause for daytime or nighttime wetting, but doctors believe that certain factors, such as bladder capacity and genetics, may play a role.

    • Depending on the type and severity of enuresis, possible treatments include nighttime alarms to wake the child to go to the bathroom, medications, bladder training and positive reinforcement.

    • A visit to a doctor that specializes in treatment of enuresis can help to identify the best treatment option to help your child. Identifying the problem earlier can help reduce stress and emotional discomfort a child can experience with wetting accidents.   

    Boston Children’s Hospital has created the Voiding Improvement Program (VIP)  to help children who have enuresis:

    • Expert physicians and nurse practitioners take a comprehensive approach to helping children overcome voiding difficulties. Request an appointment online or call us at 617-355-7796.

    Request an appointment with our Voiding Improvement Program (VIP) online or call us at 617-355-7796.

  • What is enuresis?

    Enuresis is a medical name for accidental urination in children, what most people call “wetting.” 

    Facts about enuresis:

    • It affects 10 to 20 percent of boys ages 6 to 7.
    • It affects 8 to 17 percent of girls ages 6 to 7.
    • Of the children with enuresis, 74 percent of them have wetting at night, 10 percent have wetting during the day and 16 percent have both.
    • About 15 percent of all 5-year-olds have nighttime bedwetting.
    • About 7 percent of 8-year-olds have nighttime bedwetting.

    What causes enuresis?

    A number of factors may cause enuresis, including:

    • small functional bladder capacity
    • difficulty with sleep arousal or the presence of a sleep disorder
    • a problem with the proper functioning of hormones that help to regulate urine volume
    • genetics (enuresis tends to run in families)
    • delay of your child’s body’s ability to hold urine (this may be a factor up to about age 5)
    • constipation, which is backed-up stool in your child’s intestine that can push against the bladder and cause accidental urination
    • child is too busy to stop and fully empty their bladder or they may not notice the bladder is full  

    It’s also possible that other medical conditions may be causing your child’s enuresis:

    How is it diagnosed?

    Enuresis is usually diagnosed based on a physical exam and a discussion of medical history. Some tests, including urinalysis and x-rays, may be conducted to help rule out other causes for wetting.

    How is it treated?

    The Voiding Improvement Program (VIP) at Boston Children’s Hospital takes a comprehensive and holistic approach to treating enuresis, including non-invasive methods.

    What are the long-term effects?

    Enuresis goes away on its own in 15 percent of kids each year. So, the older your child gets — even if you elect to have no treatment at all — the more likely he is to stay dry.

    However, children who have wetting problems because of an underlying medical issue may require longer treatment and care.

  • How is enuresis diagnosed?

    Enuresis is only diagnosed in children 5 years or older. The tests used for diagnosing nighttime and daytime wetting are the same.

    In most cases, enuresis is diagnosed based on a review of a complete medical history along with a physical exam. However, diagnostic tests may be used to determine if there is an underlying medical problem. These tests include:

    • urinalysis

    • uroflowmetry (a non-invasive test used to measure pattern and quality of urine flow)

    • ultrasound

    • x-ray of the abdomen and pelvis

  • If a child is over potty training age (usually 5 years old) and has frequent accidents, especially during the day, it is best to seek help from a doctor as soon as possible. Children can experience social embarrassment and as a result, emotional stress because of this problem. The earlier the problem can be identified and treated the better.

    At Boston Children’s Hospital, our Voiding Improvement Program (VIP) team takes a comprehensive and holistic approach to treat a wide variety of urinary issues.  After a thorough evaluation to diagnose any urological problems, our staff customizes a treatment plan and shares that plan with the child’s primary care doctor. When possible, we employ non-invasive methods for treatment or will refer you to the appropriate therapy option.

    Treatment for prolonged and serious forms of wetting can include:

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