What is enuresis?

Enuresis (say “en-yur-ee-sis”) is the loss of bladder control that leads to the release of urine. There are several kinds of enuresis. Nocturnal enuresis is also called “bed-wetting,” because it happens during the night while a child is sleeping. Bed-wetting is fairly common; about 5 million to 7 million children wet the bed. It may happen more often in boys than in girls.

What causes bed-wetting?

Bed-wetting isn't caused by drinking too much liquid before bedtime. It's not a psychological problem. It's not because the child is too lazy to get out of bed to go to the bathroom. And children do not wet the bed on purpose, out of spite or to irritate their parents.

Some of the causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)

• Difficulties waking up from sleep

• Slower than normal development of the central nervous system—this reduces the child's ability to stop the bladder from emptying at night

• Hormonal factors (not enough antidiuretic hormone—this hormone reduces the amount of urine made by the kidneys)

• Urinary tract infections

• Abnormalities in the urethral valves in boys or in the ureter in girls or boys

• Abnormalities in the spinal cord

How can my family doctor help?

First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis). Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

The doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will ask about your family life, because successful treatment may depend on important changes being made at home.

How will my child's bed-wetting be treated?

Most children outgrow bed-wetting without treatment. However, it's up to you and your doctor to decide if your child needs treatment. There are two kinds of treatment for bed-wetting: behavioral therapy and medicine. Whichever treatment is chosen, it's most successful when the parents, the child and the doctor work together to be supportive for the child. A diary that keeps track of wet and dry nights is helpful during treatment. It will help you and your doctor see your child's progress. It will also remind your child about how well he or she is doing during the treatment.

What is behavior therapy?

Behavior therapy is a treatment that doesn't use medicine. It's often tried before a child is given medicine. Some kinds of behavior therapy are motivational therapy, behavior conditioning, bladder-training exercises, and diet changes (limiting caffeine, dairy products, and citrus fruits or juices). Because bed-wetting is a very emotionally stressful problem for older children, your doctor might also suggest counseling.

Motivational therapy tries to take away the guilt your child feels about bed-wetting. It tries to give emotional support to your child (and to you). This treatment may work better if your family uses positive reinforcement (such as verbal praise) and reward systems to help your child keep track of his or her progress.

Behavior conditioning uses an alarm. The alarm rings or buzzes when your child first begins to wet the bed. When the alarm goes off, it wakes your child. This gets him or her into the habit of waking up in the night to go to the bathroom.

There are two kinds of alarms: one kind makes a sound and the other kind vibrates. You should keep track (in a diary) of when the alarm system is used. You should also make sure the moisture sensor is in the right place. Write down your child's response to the alarm, and keep track of his or her progress.

Bladder-training exercises help your child wait longer between trips to the bathroom. Although you may feel that your child has a “small bladder,” this usually isn't a cause of bed-wetting. However, trying to hold the urine longer during the day may help your child increase the amount of urine his or her bladder can hold at night.

What kind of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is seven years of age or older and if behavior therapy hasn't worked. But medicines aren't a cure for bed-wetting. The medicines work in two ways. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. The medicines may have side effects.

How can I make my child not feel so bad about wetting the bed?

Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry), but your child shouldn't be made to feel guilty about something he or she can't control. It's important for your child to know that bed-wetting isn't his or her “fault.”

It may help your child to know that no one knows the exact cause of bed-wetting, but that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child). It also helps to know that they can get “better” faster if everyone (the child, the family and your doctor) works together. When your child has some dry nights, he or she will begin to feel better.