06/09/2025
Bedwetting in Children (Nocturnal Enuresis): A Pediatric Surgeon’s Viewpoint
What is Nocturnal Enuresis?
Nocturnal enuresis means involuntary passage of urine during sleep in children aged 5 years or older. It is common, and most children outgrow it with time.
Primary enuresis: Child has never achieved night-time dryness.
Secondary enuresis: Child had been dry at night for at least 6 months, but starts wetting again.
Why Does Bedwetting Happen?
From a pediatric surgeon’s perspective, the causes may be functional, developmental, or occasionally surgical:
1. Delayed bladder maturation – Bladder is not yet able to hold urine overnight.
2. Overactive bladder / small bladder capacity – The bladder contracts before it is full.
3. Increased urine production at night – Sometimes due to low levels of ADH (anti-diuretic hormone).
4. Deep sleep pattern – Child doesn’t wake up to bladder signals.
5. Constipation – A full re**um presses on the bladder, reducing its capacity.
6. Psychological stress – School, family, or emotional issues may trigger secondary enuresis.
7. Surgical / anatomical causes (rare, but important for surgeons to detect):
Posterior urethral valves in boys
Neurogenic bladder (due to spinal cord problems)
Vesicoureteric reflux
Urethral obstruction
When Should Parents Worry?
Bedwetting is usually harmless, but medical evaluation is needed if:
Daytime wetting, urgency, or dribbling is also present
Child has painful urination, poor urine stream, or recurrent UTIs
Associated with constipation, spinal deformities, or weakness in legs
Bedwetting continues beyond 10–12 years despite all measures
Diagnosis
A pediatric surgeon will start with:
Detailed history (frequency, family history, fluid intake, sleep pattern)
Physical examination (abdomen, spine, genitalia)
Urine analysis and ultrasound if indicated
Rarely, uroflowmetry or voiding cystourethrogram (VCUG) in suspected anatomical problems
Treatment Approach
Treatment depends on whether it is simple functional enuresis or due to surgical pathology.
1. Parental Reassurance & Lifestyle Changes
Do not punish the child – bedwetting is not their fault.
Restrict fluids 2 hours before bedtime.
Avoid caffeinated / fizzy drinks.
Ensure regular toilet use during the day.
2. Bowel Management
Treat constipation with diet, hydration, and stool softeners if needed.
3. Bedwetting Alarm (Enuresis Alarm)
Most effective long-term non-drug therapy.
Teaches the child to wake up when bladder is full.
4. Medications (used selectively)
Desmopressin: reduces night-time urine production.
Anticholinergics: for overactive bladder.
Imipramine: rarely used, under supervision.
5. Surgical Intervention (only if anatomical cause found)
Removal of posterior urethral valves
Correction of urethral obstruction or reflux
Management of neurogenic bladder
Prognosis
Most children outgrow bedwetting naturally as the bladder matures.
With proper evaluation and management, success rates are high.
Early identification of surgical causes prevents kidney damage and improves quality of life.