Overview

Bedwetting, medically known as nocturnal enuresis, is involuntary urination during sleep in children over the age of five. It is a common condition, often seen in young children, and generally resolves as they grow older. Bedwetting can be classified into primary (when a child has never been dry at night) and secondary (when a child begins wetting the bed after being dry for at least six months).

Historically, the social stigma associated with bedwetting has led to a variety of punitive and misguided treatments. It wasn’t until the 20th century that a more comprehensive understanding of the physiological and psychological aspects of nocturnal enuresis emerged, leading to the development of more effective and empathetic interventions.

Causes

Genetic Factors: A family history of bedwetting.

Overactive Bladder: Smaller functional bladder capacity with increased sensitivity to bladder fullness.

Sleep Disorders: Deep sleep can make it difficult for a child to wake up to urinate.

Stress and Anxiety: Emotional stress or changes in the child’s environment.

Medical Conditions: Urinary tract infections, dysfunctional voiding, and/or constipation.

Hormonal Factors: Insufficient production of antidiuretic hormone (ADH) which can allow increased urine production at night.

Risk Factors

  • Constipation.
  • Male gender (boys are more likely to wet the bed than girls).
  • Developmental delays that can affect toilet training.

Complications

Emotional Impact: Can cause embarrassment, anxiety, and low self-esteem.

Social Impact: May limit social activities like sleepovers or camping.

Skin Problems: Rashes or irritation due to prolonged exposure to urine.

Infections: Urinary tract infections may be more likely with altered perineal flora.

Prevention

  • Limit fluid intake in the evening.
  • Encourage regular bathroom visits during the day and right before bedtime.
  • Establish a consistent bedtime routine.
  • Encourage bowel movements right before bedtime every night.

Symptoms

When to see a doctor