Involuntary bedwetting – referred to medically as nocturnal enuresis – in children older than five years is relatively common. It is more common in boys and there is a strong family link. Causes include not waking in response to a full bladder, producing more urine at night than the bladder can hold, or having a bladder that is overactive or of small capacity. It may only occur at night, but can also be associated with daytime symptoms  – due to an overactive bladder, chronic constipation, neurological disorder or structural abnormality – or be secondary to another problem such as diabetes, UTI or emotional upset. 

Many cases resolve without intervention, but it needs careful management as it can affect the individual’s emotional and social wellbeing and behaviour, as well as being stressful for parents and carers. Management steps include eating healthily, drinking enough fluid, avoiding caffeine, adopting good toileting habits and positive reward systems. There is a place for enuresis alarms, and medication such as desmopressin, as well as referral for expert assessment and support.

Urinary incontinence

Urinary incontinence can stem from a number of bladder problems, all of which have different causes:

• Urge incontinence occurs when the stretch receptors in the bladder wall aren’t working correctly
• Stress incontinence stems from damage to the pelvic floor or sphincter muscles meaning urine leaks out when it shouldn’t
• Mixed incontinence (a combination of urge and stress incontinence) can result from the signals between the brain and bladder not working as well as they could.