Pediatric Urinary Incontinence or Enuresis (Bedwetting)

Urinary incontinence (enuresis) is the loss of bladder control. In children younger than age 3, it’s normal to not have full bladder control. As children get older, they become more able to control their bladder. Wetting is called enuresis when it happens in a child who is old enough to control their bladder. Enuresis can happen during the day or at night. It can be a frustrating condition. But it’s important to be patient and remember that it’s not your child’s fault. A child does not have control over enuresis. And there are many ways to treat it and help your child.

There are 4 types of enuresis. A child may have 1 or more of these types:

• Nighttime (nocturnal) enuresis. This means wetting during the night. It’s often called bedwetting. It’s the most common type of enuresis.
• Daytime (diurnal) enuresis. This is wetting during the day.
• Primary enuresis. This happens when a child has not fully mastered toilet training.
• Secondary enuresis. This is when a child has a period of dryness, but then returns to having periods of wetting.

Enuresis has many possible causes. The cause of nighttime enuresis often is not known. But possible causes and risk factors may include 1 or more of these:

• Anxiety
• Attention deficit/hyperactivity disorder (ADHD)
• Certain genes
• Constipation that puts pressure on the bladder
• Delayed bladder development
• Diabetes
• Not enough antidiuretic hormone (ADH) in the body during sleep
• Obstructive sleep apnea
• Overactive bladder
• Slower physical development
• Small bladder
• Structural problems in the urinary tract
• Trouble feeling that the bladder is full while asleep
• Urinary tract infection
• Very deep sleep

Daytime enuresis may be caused by:

• Anxiety
• Caffeine
• Constipation that puts pressure on the bladder
• Stopping urine stream before finishing (dysfunctional voiding)
• Not going to the bathroom often enough
• Not urinating enough when going
• Overactive bladder
• Small bladder
• Structural problems in the urinary tract
• Urinary tract infection
• Keeping legs too close together traps urine in the vagina and urine leaks out (vaginal voiding)

A child is more at risk for enuresis if they:

• Is constipated
• Doesn’t have regular bathroom habits
• Has physical development problems
• Has anxiety

Symptoms can be a bit different for each child. The main symptom is when a child age 5 or older wets their bed or their clothes 2 times a week or more, for at least 3 months. But 1 in 10 children age 7, 1 in 20 children age 10, and 1 in 100 children older than 15 still have at least 1 episode of nighttime enuresis.

The symptoms of enuresis can seem like other health conditions. Take your child to their healthcare provider for a diagnosis.

Many children may have enuresis from time to time. It can take some children longer than others to learn to control their bladder. Girls often have bladder control before boys. Because of this, enuresis is diagnosed in girls earlier than in boys. Girls may be diagnosed as young as age 5. Boys are not diagnosed until at least age 6.

Your child’s healthcare provider will ask about your child’s health history. Tell the healthcare provider:

• If other family members have had enuresis
• How often your child urinates during the day
• How much your child drinks in the evening
• If your child has symptoms such as pain or burning when urinating
• If the urine is dark or cloudy or has blood in it
• If your child is constipated
• If your child has had recent stress in their life

The healthcare provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a health problem, such as an infection or diabetes.

In most cases, enuresis goes away over time and does not need to be treated. If treatment is needed, many methods can help. These include:

• Changes in fluid intake. You may be told to give your child less fluids to drink at certain times of day, or in the evening.
• Keeping caffeine out of your child’s diet. Caffeine can be found in cola and many sodas. It is also found in black teas, coffee drinks, and chocolate.
• Night waking on a schedule. This means waking your child in the night to go urinate.
• Bladder training. This includes exercises and urinating on a schedule.
• Using a moisture alarm. This uses a sensor that detects wetness and sounds an alarm. Your child then gets up to use the bathroom.
• Medicines. Medicines can boost ADH levels or calm bladder muscles.
• Therapy (counseling). Working with a therapist can help your child cope with life changes or other stress.

Work with your child’s healthcare provider to find out the best choices that may help your child.

Possible problems from enuresis can include:

• Emotional stress and embarrassment
• Skin rash from wet underwear

• Remember that your child can’t control the problem without help. Don't scold or blame them.
• Make sure your child is not teased by family or friends.
• Keep in mind that many children outgrow enuresis.
• Protect your child’s mattress bed with a fitted plastic sheet.
• Have a change of clothes on hand while out and about.

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms