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Bedwetting (Nocturnal Enuresis)

  • Nocturnal enuresis, better known as bedwetting, occurs when a sleeping child cannot hold his or her urine at night.

    • Don't worry—most of the time the situation resolves on its own.
    • Some children don't attain nighttime control for several years after they have complete control during the day.
    • Bedwetting occurs in 15 to 20 percent of all 5-year-old children, and in 10 percent of 7-year-olds.
    • Twenty percent of children with this problem have some degree of daytime wetting.

    How Boston Children's Hospital approaches bedwetting

    There are several options for treating bedwetting. Your pediatric urologist can help guide you to what's best for you and your child, keeping in mind that the burden of therapy shouldn't outweigh the burden of the condition itself.

    Some of the options offered here at Children's include:

    • As part of our renowned Department of Urology, Boston Children's Hospital has a dedicated Voiding Improvement Program (VIP). VIP's expert physicians and nurse practitioners take a comprehensive approach to helping children overcome voiding difficulties.

    • In addition, Children's understands that enuresis can cause emotional problems for your child. Our Division of Developmental Medicine is uniquely qualified to treat your whole child—physically and psychologically. A compassionate team of professionals address your child’s physical symptoms and emotional well-being and help your child stay dry.

    • Experts in Children's Center for Pediatric Sleep Disorders carefully learn about bedwetting and any other problems your child is having with sleep, and then thoughtfully develop a plan for solving them.

  • What causes nocturnal enuresis?

    It's important to understand that bedwetting is usually not a behavioral problem, although it sometimes occurs if your child is feeling emotional stress or insecurity.

    Some parents have the perception that their children are very "deep" sleepers, and that this is what has caused the bedwetting. However, studies have shown no difference in the sleep patterns of children who wet the bed as compared with other 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.

    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's a good idea to set up a consultation with a pediatric urologist.

    This can be important to help tailor therapy and ensure that there are no medical problems that may be contributing to or causing the nighttime wetting, such as bladder instability (unwanted bladder contractions) or posterior urethral valves (a congenital condition in boys in which the tube that carries urine out of the body has excess flaps of tissue). For this reason, a careful history of your child's complete voiding habits and bowel habits will be important.

    Here are some additional studies that your doctor may recommend:

    • Renal bladder ultrasound — This imaging examination is used to determine the size and shape of your child's kidney and bladder, and to detect a mass, stone, cyst or other obstruction or abnormalities.

    • Voiding cystourethrogram (VCUG) — An X-ray exam performed while a catheter is inserted into the urinary tract, used to see if there is any reverse flow of urine into the ureters and kidneys. Read more about VCUG in girls and boys. 

    • Urodynamics study — a test used to assess how the bladder and urethral sphincter function during the stages of bladder filling and emptying. The bladder is catheterized and filled slowly with a warm saltwater solution.

  • What are the treatments for bedwetting?

    Keep in mind that in most cases, bedwetting resolves itself without specific treatment. Sometimes simple measures, such as sticker charts or an alarm to wake your child if wetting is happening, can be helpful. Bedwetting 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 some of the following therapies:

    • behavior modification (for example, no fluids after 6 pm)
    • conditioning therapy
    • drug therapy that includes DDAVP, which replaces the natural hormone vasopressin
    • psychotherapy

    For more information

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO