Bedwetting may be a manifestation of an underlying problem. A child or adolescent with abnormal bedwetting should be evaluated in order to determine the probable cause. A treatment plan can be formulated once the cause of bedwetting has been identified.


Abnormal bedwetting:

(1) excessive urine passed

(2) failure to achieve dryness as expected in comparison with peers

(3) onset of bedwetting after a period of dryness

(4) bedwetting in conjunction with other clinical clues


Conditions associated with bedwetting:

(1) primary monosymptomatic nocturnal enuresis

(2) secondary nocturnal enuresis

(3) detrusor instability

(4) urinary tract infection

(5) neurogenic bladder

(6) posterior urethral valve

(7) ectopic ureter

(8) chronic renal failure or renal tubular disorders

(9) diabetes mellitus


Features to investigate:

(1) gender of the child

(2) family history

(3) if dryness at night was ever achieved

(4) duration

(5) amount of urine passed at night

(6) if the child wakens on wetting

(7) daytime symptoms

(8) urgency and urge incontinence

(9) emotional and stress history for the child and family

(10) evidence of urinary tract infection

(11) fecal soiling

(12) neurologic deficits in lower limbs or evidence of spina bifida

(13) palpable bladder

(14) quality of urine stream on voiding

(15) presence of polyuria and polydipsia

(16) growth retardation and/or rickets

(17) evidence anemia

(18) general state of health

(19) hypertension



primary monosymptomatic nocturnal enuresis

family history, cytogenetic abnormality (defect in chromosome 13q), lifelong bedwetting, amount passed at night may be large, child usually does not waken, no daytime symptoms

secondary nocturnal enuresis

onset of wetting after a period of dryness (6 months or more); may be associated with daytime symptoms; psychological or emotional factors may be present

detrusor instability

daytime symptoms of urinary frequency, urgency and urge incontinence, usually with a minor degree of wetness; often wake when waking at night with only a small volume voided

urinary tract infection

secondary onset wetting; symptoms of urinary tract infection; urinalysis and urine culture findings present

neurogenic bladder

constant, severe daytime wetting; fecal soiling; lumbosacral dimpling or nevus; abnormal gait; abnormal perianal or lower limb neurologic findings; palpable bladder

posterior urethral valve

male gender; poor urinary stream; daytime wetting; palpable bladder

ectopic ureter

constant dribble of urine between voidings

chronic renal failure or renal tubular disorders

polyuria and polydipsia; signs of ill health; growth retardation, hypertension, rickets, anemia, palpable kidneys, palpable bladder

diabetes mellitus

recent illness with weight loss, polyuria, thirst and polydipsia


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