Nocturnal enuresis (bedwetting)
Young children are still learning how to control their bladders and bowels.
This is why they go through “toilet training” as they learn to be independent of diapers.
Some patients and families, though, can become concerned about nighttime wetting, especially if it continues to happen at home above the age of 5 years old.
The good news
Reassuringly, bedwetting at night in the absence of other symptoms is considered a relatively benign condition.
Fifteen percent of kids who have this condition have spontaneous resolution of bedwetting every year.
This means that 15 out of 100 kids at any age, even without any treatment, can grow out of bedwetting every year.
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However, if you are concerned; if there are other symptoms associated with the bedwetting; or if it is impacting your child’s confidence or social life, you may consult a pediatrician or urologist.
Your doctor will begin by investigating:
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Has your child been toilet trained or “dry” in the past? Are they constipated?
If the child was previously dry, your doctor may need to check what caused him or her to “regress” into wetting the bed.
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Some children become chronically constipated after toilet training, and this may cause them to have poor control of both peeing and pooping.
Does your child have a history of urinary tract infections?
Does your child have a history of urinary tract infection or UTI?
Poor control of peeing can be a symptom of UTI. Your doctor may need to rule out an ongoing infection.
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Watch out for alarm symptoms including fever, vomiting, and pain of the abdomen or flanks.
Is your child under a great deal of stress?
Is your child under a great deal of stress?
​Significant life changes like family difficulties, changing schools, bullying, academic difficulties, and other stressors can contribute to urinary symptoms.
Does your child stay dry during the day?
Does your child stay dry during the day also?
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If not, then your child may not be dealing with just nighttime bedwetting, but with other conditions that affecting peeing as a whole.
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These include bladder bowel dysfunction, spine issues, overactive bladder, or congenital issues of the urinary tract.
Does your child have any other medical issues?
Does your child have any other medical issues?
Other conditions like diabetes insipidus, congenital lower urinary tract obstruction (UTO), or kidney disease can cause your child to make more urine at night.
Is your child a deep sleeper?
Is your child a deep sleeper?
Do they snore or have other symptoms of sleep apnea?
Children who have nocturnal enuresis can be deep sleepers who are not awakened by the sensation of needing to pee.
Some children or teens need a “sleep study” to see if their sleep is normal.
Depending on their findings during your visits, your doctor may then advise…
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Watching and Waiting. If there are no concerning issues your doctor may advise monitoring and follow-up, given that a number of children grow out of bedwetting without any treatment.
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Changing some habits like decreasing the amount of fluid taken before bedtime.
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Management of constipation, since “bladder bowel dysfunction” can be a cause of bedwetting.
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Medication to decrease the amount of urine produced at night.
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Tools like bedwetting alarms to “train” the child into waking up to pee at night instead of peeing on the bed.
Be patient.
For many strategies against bedwetting, it may take weeks before you see results.
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Please be patient with your child.
Bedwetting leads to a lot of distress and embarrassment for kids and teens. Celebrate dry nights and be patient and encouraging on wet ones.
When should you be worried?
While bedwetting by itself is a quite benign condition, there should be some signs to help you decide to seek medical attention:
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Recurring UTIs, especially those with fever
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A child of school age who has never been able to be “dry” during daytime and nighttime
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Changes in walking patterns/gait or sensations in the lower limbs
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Any findings on the spine or lower back, such as hair tufts, dimples, or masses
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Extreme thirst and extreme amounts of urine production
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“Continuous” wetting, specially in young girls: constantly being incontinent with urine with zero dry periods
Take home messages:
Bedwetting by itself is very common. Many children who have it will grow out of it without any help.
If you are concerned about your child’s bedwetting above 5 years old, you may discuss this with your pediatrician or urologist.
Resolving bedwetting may take time. It is very important to give your child the patience and support needed.
The information in this infographic is for general information purposes only.
We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.
Please feel free to send us a message for questions on pediatric urologic health!
