Enuresis: Bedwetting, Daytime Wetting and What to Do About Both

Two boys playing in water | Pediatric incontinence (enuresis) | Pacific Urology | East SF Bay Area

Nobody – parent or kids – has time for enuresis, which is incontinence in children

Kids have so many things to worry about these days – the latest video games, soccer practice, homework and so much more. Urinary incontinence, at night (known as bedwetting) or during the day, shouldn’t be one of them.

By age 5, more than 90% of children are able to achieve urinary continence. However, at that same age 16% of kids still have problems with bedwetting.

The number of children still having issues with bedwetting goes down significantly as the child ages. Only 1-2% of 15-year olds have issues staying dry through the night. Because the process of toilet training varies greatly depending on the child, daytime urinary problems are typically not diagnosed if the child is under age 5 or 6.

Boys tend to have more problems with nighttime incontinence while girls tend to have more issues with daytime incontinence. Both of these enuresis problems tend to resolve over time, but that does not lessen the stress or embarrassment for the parents and the kids.

Related Reading: Wetting the Bed Is More Common Than You Think

What is the cause of pediatric incontinence?

It is rare that daytime or nighttime wettings are caused by physical problems. Typically, problems stem from children getting distracted and not using the restroom, being heavy sleepers and bedwetting, and so on.

Daytime wetting

Children who struggle with daytime incontinence can have the following problems.

  • Some kids are so interested in playing they do not want to take a bathroom break. Similarly, many kids are too busy at school, daycare or home to go to the bathroom. This can mean they are only going to the restroom two to three times per day.
  • Children often do not fully empty their bladder when using the restroom. This can leave residual urine, which is the cause of the wetting.
  • That got to go “right now” feeling some children experience is caused by uncontrolled bladder contractions, and sometimes they realize that feeling to go too late to make it to the toilet in time.

Problems with daytime continence are generally not due to inappropriate toilet training, laziness or emotional issues.

Bedwetting (nocturnal enuresis)

Previously, it was thought that bedwetting was caused by a psychological or emotional problem. This thinking has changed and now it is believed those are very rarely catalysts for this problem.

There are a number of factors that could lead to bedwetting such as:

  • Kids who bed wet are most often heavy sleepers. They struggle to wake up when mom or dad tries to rouse them, which means they probably won’t wake up to use the bathroom.
  • Those children dealing with nocturnal enuresis often aren’t the first in their family. If there is a family history of siblings, parents or close family members who dealt with bedwetting, it likely passes to the child.
  • While we sleep our bodies release the hormone vasopresson, which reduces urine production. The body begins releasing the hormone in early childhood. Children dealing with bedwetting may not have enough vasopresson being produced yet.
  • Sometimes it is simply that your child is still growing.
While not common, there are certain signs to be on the lookout for that could be causes for concern. These include excessive thirst, excessive volume of urine, swelling of the feet or ankles, difficulty moving one or both legs, abnormalities of the spine, and weight loss. Certain disorders such as spina bifida, diabetes or birth defects can also cause bladder problems. Additionally, the U.S. Department of Health and Human Services notes that a serious cause for concern is if urinary incontinence appears in conjunction with signs of sexual abuse.

Learn more about the causes of daytime and nighttime incontinence.

Action items for mom and dad and when to see a doctor

There are some simple opportunities for parents to educate and work with their kids to help lessen the frequency of wetting both day and night.

  • Routine schedule. Getting your child on a regular bathroom schedule of urinating every two to three hours.
  • Avoid fluids that irritate. Fluids such as citrus juices, sports drinks, caffeinated liquids and drinks with carbonation (bubbles/fizz) can cause bladder irritation.
  • Increase water consumption during the day. Encourage your child to drink most of his or her fluids earlier in the day and limit fluids in the evening.
  • Identify the signs of constipation and treat it. Often problems with incontinence can stem from constipation. Once this issue is addressed, wetting typically stops.
  • Double void at night. Have your child use the restroom twice before bedtime. For instance, if bedtime is 9 p.m. have the child go the bathroom at 8 p.m. and again at 9.

When to see a physician for urinary incontinence

If a child is older than 6 and still having daytime wetness, it may be time for him or her to visit a physician. Bedwetting is not harmful and for those children dealing with it after age 7, it may be time to see a doctor.

We encourage parents to keep a 24-hour diary of the child’s activities to record how much fluid he or she consumed, as well as the frequency, timing and volume of urine voided throughout the day. This can be helpful for us to identify the problem and address it appropriately.

If you have questions about your child’s bedwetting or daytime wetting, contact us or schedule an appointment now.