Nocturnal enuresis is wetting that usually occurs during sleep, also called nighttime incontinence.

Diurnal enuresis is wetting when awake, also called daytime incontinence.

Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in boys as in girls.

What causes night time incontinence?

After age 5, wetting at night—often called bedwetting or sleep wetting—is more common than daytime wetting. Experts do not know what causes nighttime incontinence. The factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, infrequently, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.

What causes daytime incontinence?

Daytime incontinence that is not associated with urinary infection or anatomic abnormalities is less common than nighttime incontinence and tends to disappear much earlier than the nighttime versions. One possible cause of daytime incontinence is an overactive bladder. Many children with daytime incontinence have abnormal elimination habits, the most common being infrequent voiding and constipation.

Other Causes

Some of the same factors that contribute to nighttime incontinence may act together with infrequent voiding to produce daytime incontinence. These factors include

• Small bladder capacity.
• Structural problems.
• Anxiety-causing events.
• Pressure from a hard bowel movement (constipation).
• Drinks or foods that contain caffeine, which increases urine output and may also, cause spasms of the bladder muscle, or other ingredients to which the child may have an allergic reaction, such as chocolate or artificial coloring agents.
• Sometimes overly strenuous toilet training may make the child unable to relax the sphincter and the pelvic floor to completely empty the bladder, retaining urine, or incomplete emptying.

What treats or cures incontinence?

Most urinary incontinence fades away naturally. Here are examples of what can happen over time:

• Bladder capacity increases.
• Natural body alarms become activated.
• An overactive bladder settles down.
• Production of ADH becomes normal.
• The child learns to respond to the body’s signal that it is time to void.
• Stressful events or periods pass.
• Many children overcome incontinence naturally—without treatment—as they grow older. The number of cases of incontinence goes down by 15 percent for each year after the age of 5.
• Many children overcome incontinence naturally—without treatment—as they grow older. The number of cases of incontinence goes down by 15 percent for each year after the age of 5.
• Another medication, called imipramine, is also used to treat sleep wetting. It acts on both the brain and the urinary bladder.

Bladder Training and Related Strategies

Bladder training consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate and prevent urination when away from a toilet.

Techniques that may help nighttime incontinence include

• Determining bladder capacity.
• Drinking less fluid before sleeping.
• Developing routines for waking up.
• Techniques that may help daytime incontinence include:
• Urinating on a schedule—timed voiding—such as every 2 hours.
• Avoiding caffeine or other foods or drinks that you suspect may contribute to your child’s incontinence.
• Following suggestions for healthy urination, such as relaxing muscles and taking your time.
• Moisture Alarms: At night, moisture alarms can awaken a person when he or she begins to urinate. These devices include a water-sensitive pad worn in pajamas, a wire connecting to a battery-driven control, and an alarm that sounds when moisture is first detected. For the alarm to be effective, the child must awaken as soon as the alarm goes off, go to the bathroom, and change the bedding. Using alarms may require having another person sleep in the same room to awaken the bed wetter.

Points to Remember

• Urinary incontinence in children is common.
• Nighttime wetting occurs more commonly in boys.
• Daytime wetting is more common in girls.
• After age 5, incontinence disappears naturally at a rate of 15 percent of cases per year.
• Treatments include waiting, dietary modification, moisture alarms, medications, and bladder training.