Bedwetting (Nocturnal Enuresis)

Nocturnal enuresis, better known as nighttime bedwetting, occurs when a child who is toilet trained cannot hold their urine during sleep, typically wetting their bed once or twice a night. It is relatively common in young children: About 20 percent of 5-year-olds and 10 percent of 7-year-olds wet the bed. Fortunately, most children will outgrow night time bedwetting with time. Simple lifestyle interventions can help children have dry nights sooner, including fluid and caffeine restrictions before bed, good sleep habits, and improved toileting habits.

In cases where bedwetting is impacting quality of life, or when lifestyle changes are not successful, children may benefit from further evaluation and additional treatments. At Boston Children’s Center for Healthy Elimination and Bladder Rehabilitation (CHEER), our goal is to offer a personalized diagnostic approach to your child, to rule out anatomical problems that may lead to bedwetting, help your child stay dry throughout the night, and provide your family with support.

There is no single cause of bedwetting. In many children, it can be due to several different factors, such as:

• Genetics
• Small bladder capacity
• Sleep apnea
• Urinary tract infections (UTIs)
• Structural or anatomical differences
• Diabetes
• Neurogenic bladder
• Constipation

Although bedwetting sometimes occurs if your child is feeling emotional stress or insecurity, it isn’t usually a behavioral issue. Instead, 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 enough in many children who have a problem at night.

If your child is toilet trained but wetting the bed, 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 or structural problems that may be contributing to or causing the nighttime wetting. For this reason, a careful history of your child's complete voiding habits and bowel habits will be important.

Here are some additional tests that your doctor may recommend:

• Urinalysis to check for UTI, diabetes, or abnormal kidney function
• 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.

Most children will eventually outgrow bedwetting as they get older. Sometimes simple measures, such as sticker charts or an alarm to wake your child if wetting occurs, 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 p.m.)
• Conditioning therapy (alarm systems, which we will explain you)
• Drug therapy that includes DDAVP, which replaces the natural hormone vasopressin

The dedicated clinicians at Boston Children’s CHEER will work with your family to find the approach that works best for your child.