Bedwetting and Daytime Incontinence Program

Bedwetting (nocturnal enuresis) and daytime incontinence can be a source of frustration for parents and children. Children, especially as they get older, can feel embarrassed, anxious, ashamed and even angry about their day- and night-time wetting. Parents often feel confused, worried and sometimes even exasperated as they try to understand why the child cannot control his or her urination. At the CHOC Urology Center Bedwetting and Daytime Incontinence Program, we understand these frustrations, and work with children and their families to find solutions.

Day- and night-time wetting is typically kept a secret among families, leading many to believe that no one will understand what they are going through or that there is no actual medical treatment for the problem. Yet according to the American Academy of Pediatrics (AAP), nighttime bedwetting affects 5 million children older than age 6 in the U.S. Also, about 25% of school aged children have some form of voiding dysfunction.

The CHOC Urology Center provides our patients with the most innovative, comprehensive and clinically advanced care available.

The CHOC Urology Center is ranked among the Best Children’s Hospitals by U.S. News & World Report.

We are committed to develop evidence-based management and treatment plans and to individualize each child’s care.

Our four world-renowned fellowship-trained pediatric urologists, Dr. Antoine Khoury, Dr. Elias Wehbi, Dr. Kai-wen Chuang and Dr. Heidi Stephany are held in the highest regard for their skills as surgeons and healthcare providers.

CHOC has been ranked as one of the top children’s hospitals in the nation for Urology by U.S. News & World Report. Learn more

What is nocturnal enuresis?

Nocturnal enuresis is the medical term for bedwetting. Nocturnal enuresis may be diagnosed in children who are developmentally over the age of 6 and are still wetting the bed at night.

There are different types of bedwetting that may occur, such as primary nocturnal enuresis, which is when a child that has never had a 6-month period of dryness at night and secondary nocturnal enuresis, which is when a child who has been dry at night for over 6 months at some point in their life starts having accidents again at night.

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine for a reasonable amount of time before reaching a restroom. UI can strike at any age and can be a temporary condition or long term. It can range from the discomfort of slight losses of urine to severe, frequent wetting.

There are four main types of incontinence:

• Urge incontinence – During strong sudden urges to urinate a person is unable to hold their urine long enough to reach a restroom.
• Stress incontinence – People with this type of incontinence may leak urine during exercise, coughing, sneezing, laughing, lifting heavy objects or other body movements that put pressure on the bladder. This type of incontinence is more common in adults.
• Functional incontinence – Leakage due to a difficulty reaching a restroom in time because of a physical condition.
• Overflow incontinence – Leakage that occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it.

What can cause urinary incontinence or bedwetting?

There are many factors that may be involved, and many theories that are given for why children wet the bed at night, including:

• Constipation.
• Maturity of a child’s bladder function.
• Small bladder capacity.
• Poor sleep habits or the presence of a sleep disorder.
• Medication that affects sleep.

Commonly the cause behind why a child is wetting at night is not determined. The communication between the bladder and the brain that works during the day to let a child know when they need to use the restroom is not functioning in the same manner at night. This is a process that improves as a child ages, but can take into teenage or adulthood to occur in some individuals.

As for urinary incontinence, incontinence can be caused by a variety of concerns and will sometimes be the first or only symptom of a urinary tract infection. It may also be caused by bladder instability, small bladder capacities, poor water intake or other concerns.

We carefully assess our patients for both bed wetting and incontinence to figure out the cause and treatment plan for either.

What is the treatment for urinary incontinence?

Specific treatment for urinary incontinence will be determined by our urology specialists based on:

• The child’s age, overall health and medical history.
• Extent and type of the incontinence.
• The child’s tolerance for specific medications, procedures or therapies.
• Expectations for the course of the incontinence.
• The caregiver’s opinion or preference.

Because there are different types of incontinence, treatments vary and can include:

Behavioral therapies

Behavioral therapies help the child regain control of his or her bladder and including:

• Bladder training in which the child is taught to relax his or her bladder muscles while urinating.
• Toileting assistance in which we work with the child’s family to set routines or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking. A child should be urinating about once every two hours, or seven times per day.
• Increased water intake to ensure the child is hydrated. Clear urine is a sign of good hydration. Children should drink enough water so that their urine is clear every time he or she uses the restroom. Learn more about how much water children should drink.
• Relieving constipation, as constipation can complicate urinary symptoms greatly. Constipation can cause the bladder to have abnormal contractions and can also introduce bacteria into the urinary system. Learn more about constipation.

Pelvic muscle rehabilitation

The goal of pelvic muscle rehabilitation is to improve pelvic muscle tone and prevent urine leakage. Biofeedback is the most common form of pelvic muscle rehabilitation in which a specialized nurse teaches patients how to use their pelvic floor muscles correctly. A child will use their pelvic floor muscles to play computer games to help increase their control of these muscles. Biofeedback is non-invasive but does require the placement of stickers with sensors onto their skin around the pelvic area.

Medication

While evaluating a child’s incontinence, we look at the size of the child’s bladder. If the bladder is smaller than the average for the child’s age, the patient may be placed on medication to help the bladder relax and to grow.

Surgery

Most causes of incontinence will not require surgery. If the incontinence is related to structural problems such as an abnormally positioned ureter or sized urethra, a surgery may be recommended.

Diet modifications

Some foods and liquids can be irritating to the bladder and cause concerns of incontinence, urgency, dysuria or frequency. Learn more about bladder irritants.

Children who will be seen in our office for incontinence, urgency of urination or frequency of urination should complete a voiding diary prior to their appointment. Please contact us with any questions.

What is the treatment for bedwetting?

Specific treatment for enuresis will be determined by our pediatric urology specialists based on:

• The child’s age, overall health and medical history.
• Extent of the condition.
• The child’s tolerance for specific medications, procedures or therapies.
• Expectations for the course of the condition.
• The family’s opinion or preference.

Prior to starting treatment, it is important for caregivers to understand that it is not the child’s fault and that he or she should never be punished. Children cannot control their bed wetting. According to the American Association of Pediatrics (AAP), enuresis usually goes away on its own in about 15 percent of affected children each year. It is estimated that nearly 1 in 4 school-aged children have some degree of incontinence, and is very common.

Treatment may include:

• Positive reinforcement of the child (i.e., the use of sticker charts for dry nights).
• Use of night-time alarms to help tell the child wake up while they are urinating.
• Prescribed medications to help control the wetting for sleep-overs and vacations.
• Decreasing fluids and avoiding caffeine at night (if the child has properly hydrated during the day). Learn more about the amount of water children should consume each day.
• Medications may be recommended if the child’s bladder is found to be small for his or her age.
• Management of constipation or poor water intake.

In addition, counseling for the child and family may help to determine any stress the child may be under and can be beneficial.