Nocturnal Enuresis: Symptoms, Causes & Treatment

Nocturnal enuresis, or bedwetting, is the involuntary passage of urine during sleep in children beyond about age five, the age at which most children are expected to have gained the ability to control the bladder at night. It is among the most common childhood problems and affects a large proportion of children, especially boys.

It is very important for parents to understand that bedwetting in most cases is not a disease, not the child's fault, and not laziness, but is often the result of a natural delay in the maturation of bladder control, producing a larger amount of urine at night, or deep sleep that makes it hard to wake to the sensation of a full bladder, and a similar family history is often present. This (primary) type differs from a child who was in control then returned to wetting (secondary), which may be linked to psychological stress, a urinary infection, or other causes worth evaluating.

The reassuring news is that the vast majority of bedwetting cases improve and disappear on their own with age without any harm. The most important thing in dealing with it is support and reassurance and avoiding blame or punishment, which makes it psychologically worse. Helpful steps include reducing fluids before bed, urinating before sleep, and a positive reward system. When effective treatment is needed, alarm devices are among the most successful long-term methods, and medications prescribed by the doctor are available for certain cases. Seeing a doctor is important to rule out medical causes and set a suitable plan.

• Involuntary urination during sleep beyond age five.
• Usually without daytime symptoms in the primary type.
• In the secondary type: return of wetting after a dry period, possibly with urinary or psychological symptoms.

• A natural delay in the maturation of bladder control.
• Producing a larger amount of urine at night.
• Deep sleep that makes waking difficult.
• Family history, and sometimes psychological stress or a urinary infection (in the secondary type).

• Clinical assessment, history, and the wetting pattern.
• A urine test to rule out infection or diabetes.
• Additional evaluation when there are daytime symptoms or warning signs.

Support and habits

• Reassurance and avoiding blame and punishment, and a positive reward system.
• Reducing fluids before bed and urinating before sleep.

Effective treatments

• Alarm devices are among the most successful long-term methods.
• Medications prescribed by the doctor for certain cases or short occasions.

This content is educational and does not replace consulting a pediatrician.

• Psychological impact on the child such as embarrassment and low confidence, especially with blame.
• Avoiding sleepovers and activities.
• The secondary type may hide a medical cause needing treatment.

• There is no direct prevention, but support and avoiding night fluids help.
• A regular pre-sleep urination routine.
• Patience and reassurance, as improvement usually comes with growth.