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Bedwetting (cont.)

What Specialists Treat Bedwetting?

Routine evaluation and management of both primary and secondary enuresis should be in the domain of a pediatrician or family practice physician. If a complex cause for the child's enuresis is determined or if routine therapies are not helpful, a consultation with a pediatric urologist would be in order.

When Should a Child Seek Medical Care for Bedwetting?

The decision of when to involve your health-care professional is variable and is most commonly based on how the situation is affecting the child, as well as the parents. If the child displays only nighttime wetting without any other symptoms, then the decision about when to seek medical treatment is up to the family.

  • It is probably a good time to seek medical help when the child is 5-7 years of age.
  • Referral to a specialized enuresis clinic is likely not needed for most children with no other symptoms. This is a reasonable problem for the child's pediatrician to handle.

A child should be checked without delay for an underlying medical problem if he or she develops any other physical or behavioral symptoms.

What Exams and Tests Assess Bedwetting?

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 or ultrasound 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.

Last Reviewed 11/21/2017
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Enuresis »

The word enuresis is derived from a Greek word that means "to make water."

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