Bedwetting in children (enuresis nocturna): causes, diagnosis and treatment

Nocturnal enuresis—medically known as enuresis nocturna—refers to the involuntary release of urine during sleep in children aged four to five years and older. During the day, most affected children have no trouble controlling their bladder. At night, however, they regularly experience involuntary bedwetting. Sometimes, they also experience an increased urge to urinate during the day.

How common is bedwetting?

Bedwetting is widespread and no cause for concern:

• 15 to 20 percent of all children under five years of age occasionally wet the bed
• Boys are affected more often than girls
• Most children become dry on their own over time
• Only a small proportion requires specific treatment

Causes of bedwetting

Nocturnal enuresis can have various causes:

Genetic predisposition

Bedwetting tends to run in families. If a parent was affected as a child, the likelihood of the child experiencing it increases significantly.

Functional causes

Delayed maturation of bladder control is the most common cause. The interaction between the bladder and the brain does not yet function reliably at night.

ADH deficiency

The antidiuretic hormone (ADH) normally ensures that the kidneys produce less urine at night. If too little ADH is released, the bladder fills up faster than the child can wake up.

Organic causes

In rare cases, underlying causes may include urinary tract malformations, urinary tract infections, or neurological disorders.

Psychological factors

Exciting experiences, changes in the child’s environment (starting school, a new sibling, moving), or stressful situations can temporarily lead to a recurrence of bedwetting.

Types of bedwetting

A distinction is made between:

• Nocturnal enuresis: Most common—the child wets the bed exclusively while asleep
• Daytime wetting: Less common, but also possible
• Combined form: Wetting both during the day and at night
• Primary enuresis: The child has never been consistently dry
• Secondary enuresis: The child is wetting again even though they were previously dry

Diagnosis by a urologist

The urological evaluation involves several steps:

• Physical examination: Assessment of the genitals and urinary tract
• Urinalysis: To rule out infections and other abnormalities
• Ultrasound: Imaging of the kidneys and bladder to rule out organic causes
• Psychological assessment: Identification of potential stress factors
• Bladder diary and bedwetting log: Documentation of drinking and toilet habits

Treatment and Tips for Parents

Treatment depends on the cause and is tailored individually to your child:

• No punishment: Scolding or punishment makes the problem worse. Bedwetting is not intentional.
• Positive reinforcement: Praise your child for every dry night
• Regulate fluid intake: Have your child drink less in the evening without restricting them
• Keep a bladder diary: Helps the doctor identify patterns and adjust treatment
• Wake-up devices (alarm pants): A proven tool that wakes the child at the first sign of wetting
• Medication: Temporary hormone treatment can help in cases of ADH deficiency

With patience, medical guidance, and the right treatment approach, bedwetting can be successfully treated in most cases.