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: Creatinine

What It Is

Creatinine is a waste product that the muscles produce at a steady rate as part of normal daily activity. The bloodstream carries creatinine to the kidneys, which filter it out of the blood, and it is passed out of the body in urine.

A urine creatinine test measures the amount of creatinine in the urine. It can be done on its own or with other tests that determine the relative amounts of other substances being excreted in the urine.

Why It's Done

Healthy kidneys filter the blood to rid it of waste products that the body can't use. Low levels of creatinine in the urine may point to a kidney disease, certain muscular and neuromuscular disorders, or an obstruction of the urinary tract. If test results are abnormal, other tests will be done to make a specific diagnosis.

A creatinine clearance test measures the blood creatinine level as well as how much creatinine is being passed in the urine over several hours. This gives doctors information about how well the kidneys are functioning.

A doctor may order a urine creatinine test in combination with other urine tests even when no kidney dysfunction is suspected. Because creatinine is filtered out at a fairly steady rate, doctors compare the creatinine level with levels of other substances in the urine to determine if they're being excreted at a normal rate.

Preparation

Your child might need to temporarily stop taking certain drugs that affect the urine's creatinine levels and might be asked to not eat large quantities of meat in the day or two before the test.

The Procedure

Collecting the specimen should only take a few minutes. 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 small catheter may need to be inserted into the bladder to obtain the urine specimen.

If you collect the specimen at home, follow any storage and transportation instructions the lab gives you.

For a creatinine clearance test, you'll need to collect all the urine your child passes over a period of several hours (usually 24 hours). This usually involves first getting a special container from the lab in which to collect the urine, plus specific instructions about how to collect and store the timed urine sample.

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.

Getting the Results

In general, the results of the urine creatinine test are available within a day or two. Your doctor will go over the results with you and explain what they mean. If abnormalities are found, further tests may be needed.

Risks

No risks are associated with taking a urine creatinine test.

Infants may occasionally experience skin irritation from the adhesive tape on the collection bag. If a catheter is used to obtain the urine, it may cause temporary discomfort. If you have any questions or concerns about this procedure, talk to your doctor.

Helping Your Child

Collecting the specimen for a urine creatinine test is usually painless. Explaining how the test will be conducted and why it's being done can help ease any fear. Make sure your child understands that there should be no foreign matter, such as toilet paper or hair, in the sample.

If You Have Questions

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

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