Enuresis (Bedwetting)

About Enuresis

Enuresis is involuntary urination (peeing) beyond the age of anticipated urinary control. It may include nighttime wetting, like bedwetting, and/or daytime wetting. The wetting can occur frequently or rarely. There are possible structural or neurological disorders that can result in a child wetting, but usually involuntary peeing is the result of a functional disorder (a condition where a bodily function is impaired without a structural or anatomical cause).

What causes bedwetting?

Bedwetting is a common problem in kids, especially children under the age of 6 years. In fact, according to the American Academy of Pediatrics, most children do not become fully toilet trained until they are between 2 and 4 years of age. About 13% of 6-year-olds wet the bed, while about 5% of 10-year-olds do.

No one knows for sure what causes bedwetting or why it stops, but it’s usually a natural part of development and not a sign of any deeper medical or emotional issues. Bedwetting often runs in families: kids who wet the bed often have a relative who did, too. If both parents wet the bed when they were young, it's very likely that their child will, but most children grow out of it.

Bedwetting usually goes away by itself, but until it does, it can be embarrassing and uncomfortable for your child. It’s important to be sensitive to your child’s feelings about bedwetting and provide support and positive reinforcement.

When to See a Doctor about Enuresis

Bedwetting that begins abruptly or is accompanied by other symptoms can be a sign of another medical condition, so be sure to call a doctor if your child has any of these:

  • suddenly starts wetting the bed after being consistently dry
    for at least 6 months
  • begins to wet his or her pants during the day
  • starts misbehaving at school or at home
  • complains of a burning sensation or pain when urinating
  • has to urinate frequently
  • is drinking or eating much more than usual
  • has swelling of the feet or ankles
  • is still wetting the bed at age 7 years
Nocturnal Enuresis (Nighttime Wetting)

Wetting at night after the age of 4 years old may be related to a relative immaturity of how the body controls urine production at night. During sleep a hormone (vasopressin) helps reduce urine production and in some children, not enough of this hormone is released at night. Commonly, these children can be very heavy sleepers and not recognize that their bladder is full and they need to wake up.

Diurnal Enuresis (Daytime Wetting)

Wetting that occurs involuntarily during the day may be caused by a voiding dysfunction such as:

  • Overactive Bladder (Urge syndrome) is associated with frequent episodes of urgency and small bladder capacity (found in two-thirds to three- quarters of children with daytime wetting)
  • Dysfunctional Voiding is related to how the bladder muscles work (there may also be an increased risk of urinary tract infections and constipation)
  • Dysfunctional elimination syndrome includes both significant constipation along with involuntary wetting
  • Other conditions like Giggle incontinence (peeing with laughing, sneezing, or coughing) and Vaginal Reflux (urine caught in the vagina) may cause daytime wetting

How is Enuresis treated?

Our medical team will first evaluate your child for conditions like a bladder infection, an anatomical problem, or a neurological disorder. If none are found, then we may consider therapy that includes committing to a home management plan to help monitor your child’s progress and behaviors, as well as keeping a bladder/bowel daily diary. It may take some time to see improvement, but we will be with you and your child every step of the way, providing gentle, compassionate support.

Urine Test: Dipstick

What It Is

A urine dipstick test is often done as part of an overall urinalysis, but it can also be done on its own, depending on the doctor's concerns. Once a urine sample is collected, a nurse or technician will place a specially treated chemical strip (dipstick) into your child's urine. Patches on the dipstick will change color to indicate the presence of such things as white blood cells, protein, or glucose.

Why It's Done

The results of a urine dipstick test may point to a diagnosis of urinary tract infection (UTI), kidney disease, diabetes, or a urinary tract injury. If test results are abnormal, other tests will be needed before a definite diagnosis can be made.

Preparation

No preparation other than cleansing the area around the urinary opening is required for the urine dipstick test.

The Procedure

Your child will be asked to urinate into a clean sample cup in the doctor's office. If your child isn't potty trained and can't urinate into a cup, a catheter (a narrow, soft tube) may need to be inserted into the bladder to obtain the urine specimen.

The skin surrounding the urinary opening has to be cleaned and rinsed just before the urine is collected. In this "clean-catch" method, you or your child cleans the skin around the urinary opening with a special towelette. The child then urinates, stops momentarily, and then urinates again into the collection container. Catching the urine in "midstream" is the goal. Be sure to wash your hands and your child's hands after this process.

Once collected, the technician or nurse will then place the dipstick into the urine sample. Collecting the specimen should only take a few minutes.

What to Expect

Because the test involves normal urination; there shouldn't be any discomfort as long as your child can provide a urine specimen. It's important to keep the area around the urinary opening clean before the test and to catch the urine sample midstream.

Getting the Results

The results of the urine dipstick test will be available right away. If abnormalities are found, further urine tests will be needed. Talk to your child's doctor about the meaning of the specific test results.

Risks

No risks are associated with taking a urine dipstick test. If a catheterized specimen is required it may cause temporary discomfort and you can discuss any questions you have about this procedure with your healthcare provider.

Helping Your Child

The urine dipstick test is painless. Explaining how the test will be conducted, and why it's being done, can help ease your child's fear. Make sure your child understands that the urinary opening must be clean and the urine must be collected midstream.

If You Have Questions

If you have questions about the urine dipstick test, speak with your doctor.

Reviewed by: Yamini Durani, MD
Date reviewed: February 2012