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Medical Author:

John Mersch, MD, FAAP

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The health-care provider will ask many questions about the child's symptoms and about many other factors that can contribute to bedwetting. These include the following:

• The pregnancy and birth
• Growth and development, including toilet training (both urine and stool)
• Medical conditions. Specific attention is focused on the following:
• Wetness of underwear: indicates day and nighttime enuresis
• Palpating stool in the abdomen: indicates possible constipation or other obstruction
• Excoriation of genital or vaginal area: possible scratching due to pinworms
• Poor growth and/or high blood pressure: possible kidney disease
• Abnormalities of the lower spine: possible spinal cord abnormalities
• Poor urinary stream or dribbling: possible urinary abnormalities
• Medications, vitamins, and other supplements
• Family history if one or both parents were enuretic, approximately one-half to three-quarters of their offspring may also wet the bed. Identical twins are twice as likely to both be enuretic when compared to fraternal siblings.
• Home and school life: recent stress, how this problem is affecting the child and family, any attempts at therapy which have been tried
• Behavior
• Toilet habits: Record a voiding diary (daytime pattern and volume of urine, to determine bladder volume) and stool diary (to evaluate for constipation).
• Nighttime routines
• Diet, exercise, and other habits: Is there caffeine intake?

There is no medical test that can pinpoint the cause of primary enuresis. Secondary enuresis more commonly reflects underlying pathology and thus warrants laboratory and possibly radiologic evaluation.

• A routine urine test (urinalysis) usually is performed to rule out any urinary tract infection or kidney disease.
• An X-ray of the kidneys and bladder may be done if a physical problem is suspected. Occasionally, MRI examination of the lower spine/pelvis is indicated.

Generally, medical professionals divide bedwetting into uncomplicated and complicated cases.

• Uncomplicated cases consist of only bedwetting with no other symptoms, a normal urinary stream, and no daytime urination complaints or soiling. These children have a normal physical exam and urinalysis findings.
• Complicated cases may be any of the following: wetting in relation to another disease or condition, problems urinating, soiling or daytime urinary incontinence, or urinary tract infections. These children require further evaluation.

Children who have complicated bedwetting may be referred to a specialist in urinary tract problems (urologist) for further evaluation.

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