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Some diseases causing bedwetting Diabetes insipidus (which causes production of large amounts of dilute urine). Diabetes mellitus. Kidney diseases. Some nervous system or spine disorders. Urinary tract infection. Irritable bladder. Constipation. Bladder stone.
When to treat bed wetting When the child wants it. Parents tend to get worried about the problem when children are 4-5 years old.  The child is usually not bothered till the age of 7-8 years.  That's when treatment should be given -- when the child is concerned, and wants to stop wetting the bed. Treatment of bed wetting is always strenuous, and sometimes expensive.  Unless the child is strongly motivated, success is very unlikely.  It is not sensible to force treatment on a child who is not motivated to stop wetting the bed.

Bed Wetting (Nocturnal
Enuresis) in Children

All babies wet their beds, of course, but what we are talking about is passing urine during sleep at an age when control is expected.  About 20% of children at age 5 wet their beds, and about 15% of them achieve control every year.  Most of these children are boys.

There are two types of nocturnal enuresis.  Primary nocturnal enuresis refers to children who have always been wetting their beds at night.  Secondary nocturnal enuresis refers to those children who had achieved control, but have again started wetting their beds.  The second type is likely to have an underlying physical or psychological disorder.

Where's the problem?

The main problem, in children with primary nocturnal enuresis, is that they do not awaken when the urinary bladder is full.  This is perhaps due to a delay of maturation of the nervous system.  Scientific studies have found these children to be difficult to wake from sleep.  Some of these children have small bladders, and a few may have urgency of urination-- inability to hold the urine when the bladder is full.

Normally, urine production at night is less than daytime, under the influence of a hormone called ADH (anti diuretic hormone).  It is suspected that children who wet their beds do not have enough ADH at night.  This has not been proved.  Some children habitually drink a lot of water or other fluids, and produce a lot of urine.

Looking into the problem

Children with primary enuresis do not often benefit from a series of laboratory tests.  Only a few of them have an underlying disease (see box) as the cause of their bedwetting.  Children whose bedwetting is caused by any of these disorders will benefit from treatment aimed at it.  

During a consultation for this problem, a child specialist will examine the child carefully for any signs of these diseases.  Only a few children will need investigations in a laboratory.

It is important to assess bladder capacity.  This can be done by having the child drink liquids, and then measure the urine output when he says he needs to go.  The normal capacity, in ounces, is the age in years plus 2.  That is, a child of 5 years should have a capacity of seven ounces (1 ounce = approximately 30 ml).  The normal adult bladder capacity is 12-16 ounces.

If the bladder capacity is normal, treatment is likely to be successful.  Treatment is more difficult in children with small bladder capacities, though parents are often happy to find this problem (it's the bladder's fault, not their child's!)

Treatment of bed wetting

Last revision: July 15, 2007

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