Basic Facts

  • Enuresis is a child’s involuntary release of urine at an age when he or she should be able to control urinary function.
  • Nocturnal enuresis (enuresis that occurs at night) is the most common form of enuresis.
  • In most cases, children with enuresis are physically and psychologically normal.

Enuresis is a child’s involuntary release of urine at an age when he or she should be able to control urinary function. Usually the child is around age 5 or 6. Enuresis can occur during the day, referred to as diurnal enuresis. More commonly, enuresis occurs at night, which is called nocturnal enuresis or bedwetting. Enuresis is a normal part of development and most children outgrow it. Enuresis rarely has an underlying physical cause.

Nocturnal enuresis is categorized into two types. A child can either have primary nocturnal enuresis, in which he or she has never learned to control his or her bladder functions and eventually outgrows the bedwetting. Or a child can have secondary nocturnal enuresis, in which he or she has learned bladder control but develops enuresis again after 6 months of staying dry.

Enuresis is not painful; however, it can embarrass children, create anxiety, diminish self-esteem, and prevent children from developing social relationships.

Because nocturnal enuresis is involuntary, the child should never be punished.


Nocturnal enuresis is neither a condition nor an illness; therefore, it has no symptoms.


The majority of children who wet the bed at night are physically healthy and emotionally sound. Although physicians do not know a definitive cause, they have many theories to explain the primary nocturnal enuresis, including:

  • Delay in physical development; and
  • Low levels of arginine vasopressin.

Causes of secondary nocturnal enuresis may include:

  • Overactive bladder;
  • Anxiety or stress.

Approximately 1 percent of enuresis cases may be caused by a physical problem such as:

  • Urinary tract infection;
  • Constipation;
  • Neurogenic bladder;
  • Obstructive sleep apnea;
  • An obstruction in the urethra or ureter;
  • Diabetes mellitus;
  • Diabetes insipidus;
  • Heart block; or
  • Hyperthyroidism.

In these cases, nocturnal enuresis may be a symptom of the underlying condition or disorder.

Children are at greater risk for enuresis if their parents also experienced enuresis as a child. Generally, children will stop wetting the bed at night around the same age that their parents stopped.


The physician will conduct a history and physical examination. He or she may instruct the parents and child to keep a voiding diary for 1 to 2 weeks.

If the physician suspects that the bedwetting may be caused by an underlying condition or illness, he or she may order a urinalysis or an x ray. Other tests that may be performed include:

  • Voiding cystourethrogram (VCUG);
  • Cystoscopy;
  • Magnetic resonance imaging (MRI);
  • Urine flow study; or
  • Electrocardiogram (ECG).


Nocturnal enuresis is usually not considered a problem until the child reaches the age when he or she should be able to control urination, usually around age 5 or 6. If the physician decides that a treatment approach is necessary, he or she may begin with behavior modification techniques, such as:

  • Alarm therapy;
  • Bladder training; or
  • Responsibility reinforcement.

For children who do not improve with behavior modification after 1 month, the physician may recommend one of the following medications:

  • Desmopressin acetate (DDAVP);
  • Imipramine; or
  • Anticholinergic therapy.
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