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Nocturnal Enuresis (bedwetting)

How common is enuresis (bedwetting)?

Nocturnal enuresis (bedwetting) is very common in the first few years after toilet training and most children outgrow their bedwetting as this survey of 1265 children in New Zealand shows:

Age (years)    Children with Nocturnal Enuresis (%)

      3                                        43.2
      4                                        20.2
      5                                        15.7
      6                                        13.1
      7                                        10.3
      8                                          7.4

Some bedwetters do not produce the normal high levels of vasopressin (a hormone that helps recycle water from urine) at night and therefore make more dilute urine than they should at night. In addition, they don't seem to get the message that the bladder is full and as a result have accidents when asleep.

How is enuresis diagnosed?

Bedwetting can be a symptom of urinary tract infection or abnormalities of the urinary tract and, if associated with painful urination, stream abnormality, or daytime incontinence, should be fully evaluated. Usually a diagnosis of isolated bed-wetting can be made after performing a careful history, physical examination, and inspection of the urine (and, in some situations, ultrasound or other imaging tests).

How is enuresis treated?

Because most bedwetters become dry without treatment, patience and understanding  are the best things to offer young children who bed wet. However, by 6-7 years of age children are eager to go to camp or on sleepovers and treatment may be desired.

As an initial step we recommend fluid restriction. This may be sufficient for some children, but even if not successful is continued when other treatment programs are started. Some parents also find that waking the children at night may help, but this should be done only if does not disrupt sleep patterns (the child and parent!). Alarm systems can be tried next, although some alarms are better than others, and our pediatric urology team will be glad to advise you. Behavioral modification is occasionally helpful, with a reward system for dry nights. However, the child should not be punished for wetting. Medications may be necessary as a last resort.

What medications are available for treatment of enuresis?

Imipramine (an antidepressant known as Tofranil) helps in a little more than 50% of bedwetters, but it can cause mood changes and nightmares. Oxybutynin chloride (Ditropan, a bladder antispasmodic) also is effective in half the children but may cause facial flushing, irritability, and even heat exhaustion (making it essential that children drink plenty of water in the summer months. DDAVP (a synthetic version of vasopressin, an important regulatory hormone that our bodies normally produce) may be prescribed. DDAVP recycles water from the urine back into the bloodstream so less urine is made at night. Children should be followed carefully when on any of these medications and dosages should not be increased without careful instructions from the doctor. If you have any questions about your child's condition, please do not hesitate to talk with one of our staff.

This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at The University of Texas Medical School and is presented to inform you about surgical conditions. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about surgical treatment. If you have any questions about the information above or your child's care, please contact our doctors.