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.

Ultrasound: Renal (Kidneys, Ureters, Bladder)

What It Is

A renal ultrasound is a safe and painless test that uses sound waves to make images of the kidneys, ureters, and bladder.

The kidneys are a pair of bean-shaped organs located toward the back of the abdominal cavity, just above the waist. They remove waste products from the blood and produce urine. The ureters are thin tubes that carry the urine from the kidneys to the bladder.

During the examination, an ultrasound machine sends sound waves into the kidney area and images are recorded on a computer. The black-and-white images show the internal structure of the kidneys and related organs.

Why It's Done

Doctors order renal ultrasounds when there's a concern about certain types of kidney or bladder problems. Renal ultrasound tests can show:

  • the size of the kidneys
  • signs of injury to the kidneys
  • abnormalities present since birth
  • the presence of blockages or kidney stones
  • complications of a urinary tract infection (UTI)
  • cysts or tumors

Preparation

Usually, you don't have to do anything special to prepare for a renal ultrasound, although the doctor may ask that your child not eat or drink anything for several hours before the test.

You should tell the technician about any medications your child is taking before the test begins.

Procedure

The renal ultrasound will be done in the radiology department of a hospital or in a radiology center. Parents are usually able to accompany their child to provide reassurance and support. Your child will be asked to change into a cloth gown and lie on a table. The room is usually dark so the images can be seen clearly on the computer screen.

A technician (sonographer) trained in ultrasound imaging will spread a clear, warm gel on your child's abdomen over the kidney area. This gel helps with the transmission of the sound waves. The technician will then move a small wand (transducer) over the gel. The transducer emits high-frequency sound waves and a computer measures how the sound waves bounce back from the body. The computer changes those sound waves into images to be analyzed.

Sometimes a doctor will come in at the end of the test to meet your child and take a few more pictures. The procedure usually takes less than 30 minutes.

closeUp_ultrasound_illustration

What to Expect

The renal ultrasound test is painless. Your child may feel a slight pressure on the abdomen as the transducer is moved over it. You'll need to tell your child to lie still during the procedure so the sound waves can reach the area effectively. The technician may ask your child to lie in different positions or hold his or her breath briefly.

Babies might cry in the ultrasound room, especially if they're restrained, but this won't interfere with the procedure.

ultrasound_illustration

Getting the Results

A radiologist (a doctor who is specially trained in reading and interpreting X-ray and ultrasound images) will interpret the ultrasound results and then give the information to the doctor. You and your doctor will go over the results. If the test results appear abnormal, your doctor may order further tests.

In an emergency, the results of an ultrasound can be available within a short period of time. Otherwise, results are usually ready in 1-2 days. In most cases, results can't be given directly to the patient or family at the time of the test.

Risks

No risks are associated with a renal ultrasound. Unlike X-rays, radiation isn't involved with this test.

Helping Your Child

Some younger children may be afraid of the machinery used for the ultrasound test. Explaining in simple terms how the renal ultrasound test will be conducted and why it's being done can help ease your child's fears. You can tell your child that the equipment takes pictures of his or her kidneys.

Encourage your child to ask the technician questions and to try to relax during the procedure, as tense muscles can make it more difficult to get accurate results.

If You Have Questions

If you have questions about the renal ultrasound, speak with your doctor. You can also talk to the technician before the exam.

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