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Urination - bed wetting

Definition

Bed wetting (or enuresis) is when children wet the bed more than twice per month after age 5 or 6.

Alternative Names

Enuresis - bedwetting

Considerations

Children develop complete control over their bladder at different ages. Nighttime dryness is usually the last stage of toilet learning.

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.

Around 7% of children still wet their beds at age 5, only 3% do so by age 10, and 2% by age 15. Only 1 out of 100 children who wet their bed continue to have a problem in adulthood.

Causes

Children who were dry for at least 6 months and then started wetting again have secondary enuresis. There are many reasons why children wet the bed after being fully toilet trained. These include:

• Diabetes
• Psychological problems or medical disorders, such as a urinary tract infection
• Urinary tract abnormalities

Home Care

Do not worry about bed wetting in children before age 6, unless they were previously well toilet trained and the bed wetting is a new problem.

Do not punish a child who wets. Bed wetting 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 your child that bedwetting is common and can be helped. You can also have your child take an active part in cleaning up from the bed wetting (such as helping to strip the bed and put the sheets in the laundry).

Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep.

You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids too much. Avoiding drinks that contain caffeine can also help.

Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. Although this is unlikely to completely solve the problem, it can help. Try it before you use medicines. It is most useful in children 5 - 8 years old.

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. These drugs stop bed wetting in 60 - 75% of children who take them, but they are not a permanent cure (once the medication is stopped, the bed wetting tends to come back).

When to Contact a Medical Professional

Call your doctor if:

• Your child has had repeated episodes of bed wetting after age 6
• Your child complains that it hurts to urinate
• Your child has been drinking excess amounts of fluids
• Your child has been showing strange behavior changes (becoming unusually withdrawn or shy, or suddenly behaving in a sexually suggestive way)

What to Expect at Your Office Visit

The health care provider will take a medical history from the patient and his or her 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 does the child urinate during the daytime?
  • Does the child have a problem controlling urine while awake?
  • Does bed wetting cause the child to wake up?
  • 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?
  • Does the child drink beverages containing caffeine or alcohol?
• Relieving factors
  • Is there anything that reduces the problem?
• Other
  • What other symptoms are also present?
    • Abdominal pain
    • Back pain
    • Fever
    • Pain or burning when urinating
  • What medications is the child taking?
  • Have other family members had this problem?
  • Is there a family history of diabetes?
  • Is bowel control a problem?
  • Can the child feel the need to urinate?
  • What prevention methods have been tried?
    • Alarm systems
    • Diapers
    • Periodic waking
    • Restricting fluids
    • Rewards

A complete examination will be performed, with emphasis on the abdomen, rectum, and urinary opening. The health care provider will discuss the available treatment options.

Diagnostic tests will not be done unless your health care provider believes there is a medical problem.

After seeing your health care provider:

If your health care provider made a diagnosis related to bed wetting, you may want to note that diagnosis in your personal medical record.

References

Boris NW, Dalton R. Vegetative disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.

Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360:1429-1436.

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