What is nocturnal enuresis?

Nocturnal enuresis is wetting while asleep in children 5 years of age and older. A child with nocturnal enuresis wets only during sleep and urinates normally when awake.

How many children have nocturnal enuresis?

• 5 to 6 years: 15-20 percent
• 8 to 10 years: 6-10 percent
• 11 to 13 years: 4-5 percent
• 14 to 16 years: 2-3 percent
• 17-18 years: 1-2 percent

Causes

There are several factors that can lead to bedwetting including:

• Bedwetting can be hereditary. If there is a family history of parents, siblings, or other close relatives with nocturnal enuresis, it is more likely that your child will inherit the condition.
• Most children with nocturnal enuresis are very heavy sleepers. These children don’t wake up when their bladder is full.
• During sleep a hormone (vasopresson) is released in the body; it reduces urine production. When the body starts to produce vasopresson is variable, but it usually happens in early childhood. If your child’s body is not yet producing vasopresson, he may make more urine than the bladder can hold.
• It takes time for the bladder to mature and stay relaxed while your child sleeps.

Treatment

Each year, we treat more than 700 children for nocturnal enuresis. With the experience and expertise of our DOVE team, we can decide what approach may help your child and work best for your family.

Voiding Calendars

Your child’s visit with us will include a thorough history. We want to understand your child’s daytime voiding and stooling habits as these may contribute to the night wetting. Many children who do not void regularly during the day will wet at night. Working to change daytime voiding and stooling habits may reduce the degree of night wetting.

Recommendations to optimize daytime voiding include:

• Increasing the amount of water consumed during the day. Many children tend to drink most of their fluids between the time they get home from school and bedtime. We encourage children to drink most of their fluids earlier in the day.
• Limiting fluids two hours before bedtime.
• Urinating on a routine schedule of every two to three hours.
• Double voiding before bed. If bedtime is at 8 p.m., have your child empty her bladder at 7 p.m. and then again at 8 p.m.
• Monitoring for any signs of constipation and treating it if needed.
• Cutting back on drinks that contain ingredients that irritate the bladder: caffeine, carbonation (fizz/bubbles), citrus juices and sports drinks.

If the night wetting persists after fine-tuning the daytime habits, there are two main options to help manage your child’s wetting:

The bedwetting alarm

The bedwetting alarm is a form of conditioning therapy to help your child begin to recognize the need to wake up to go to the bathroom. Bedwetting alarms consist of a sensor to detect wetness and an alarm to awaken the child. The alarm rings when your child starts to release urine. It works for 60 to 70 percent of children and requires a high level of commitment from the child and family.

It may take three to four months to accomplish mostly dry nights. There should be signs of progress in the first few weeks with a smaller amount of urine voided at night and with your child beginning to awaken on his own. Eventually the alarm triggers your child to wake up when his bladder is full.

Medication

Desmopressin (DDAVP®) concentrates urine so that your child makes less urine at night and does not completely fill the bladder. DDAVP® is effective in about 50 percent of patients.

We understand how stressful night wetting can be for you and your child. We will work with you to find the best treatment plan for your family. We will continue to follow your child in our DOVE program to maximize dry nights.

Reviewed by: Division of Urology
Date: January 2014