Desmond Kaplan MD FAPA

Child, Adolescent & Adult Psychiatry

1777 Reisterstown Road, Suite 50
 Baltimore, MD 21208

Bedwetting in Children

Bedwetting, also known as or nocturnal enuresis, refers to nighttime incontinence in children once they have been toilet-trained. Occasional bedwetting, especially in boys, is not uncommon up until the age of 7. After that time, medical consultation and treatment may be required. Bedwetting is more likely to occur in children who have a family history of the problem and in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). In the majority of cases, bedwetting simply indicates a slight delay in this particular area of development.

Causes of Bedwetting

Although there may be underlying physical causes of bedwetting, some of which may be serious, in most cases the causes are relatively benign. Causes of bedwetting include:

  • Chronic constipation
  • Diabetes
  • Hormonal imbalance
  • Inability to recognize a full bladder
  • Small bladder
  • Sleep apnea
  • Stress
  • Urinary tract infection

In some rare cases, bedwetting is the result of a neurological or urological defect. Only 5 to 10 percent of bedwetting cases are demonstrated to be the result of serious medical conditions.

Diagnosis of Bedwetting

Bedwetting requires medical consultation if it persists after the age of 7, if the child experiences nocturnal incontinence after being dry at night for several months, if the child is unusually thirsty, experiences hard stools, snores or has pain during urination. Blood in the urine is also a sign of more serious trouble. In diagnosing bedwetting, the doctor will check the child through physical examination and a discussion of any unusual stressors, such as starting school, moving, bullying or parental divorce.

Diagnosis of bedwetting may also involve the following:

  • Urine tests to detect or rule out infection or diabetes
  • X-rays, CT or MRI scans of the urinary tract
  • Blood tests
  • Tests for apnea or other sleep disorders

If severe constipation is an issue, the doctor may order other diagnostic tests, such as anorectal manometry, colonoscopy or sigmoidoscopy.

Treatment of Bedwetting

Often the biggest problems associated with bedwetting are emotional ones. A child who continues to wet the bed may feel ashamed, babyish or out of control. Extensive research has shown that the less fuss made about the problem by parents, the better. Punishment only makes the problem worse.

If an underlying disease condition or anatomical anomaly is found, then it must be treated to resolve the problem. If there is severe stress in the child's life, it should be addressed. Counseling and/or anti-anxiety medication may offer relief. In cases where the child's development lags behind in this one area, the following treatments may be helpful.

Moisture Alarms

Moisture alarms consist of a battery-operated pad that is sensitive to moisture. When the pad becomes even slightly damp, it sets off an alarm as the child begins to urinate. Hopefully, the child is awakened in time to reach the toilet to finish urinating. Once the child is trained to tune in to first sign of urination, the moisture alarm can be a good long-term solution.


If the moisture alarm is ineffective, one of two medications may be prescribed: Desmopressin (DDAVP) to keep nighttime production of urine low or Osybutynin (Ditropan XL) to reduce bladder contractions and increase bladder capacity. A combination of medications is sometimes more effective than one type of medication alone. Many doctors are reluctant to use these medications because they can cause side effects and because they only work for as long as they are taken. Nonetheless, these medications may be helpful in allowing children with bedwetting problems to participate in sleepovers, school trips or summer camp without fear of embarrassment.

When bedwetting is due to a developmental delay, it does not have serious medical consequences. It's physical problems are usually limited to rashes on the buttocks, genital, or perianal areas. Emotionally, however, the consequences of an ongoing bedwetting problem can be severe and long-lasting, so the condition requires medical and/or psychological intervention.

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