Bedwetting (Nocturnal Enuresis) in Children

Nocturnal enuresis (bedwetting) is involuntary urination during sleep in children old enough to be expected to control their bladder. Bladder control during the day is typically achieved by age 3–4; night-time dryness follows later, usually by age 5–7.

Bedwetting is very common: approximately 15% of 5-year-olds, 5% of 10-year-olds, and 1% of adolescents wet the bed. It is more common in boys. The large majority resolve spontaneously.

Bedwetting is almost always not a behaviour problem and is not the child's fault. It is caused by a combination of factors: producing too much urine at night (relative deficiency of antidiuretic hormone during sleep), a small functional bladder capacity, and difficulty waking in response to a full bladder. There is a strong genetic component — 70–80% of children who wet the bed have a parent who had the same problem.

Secondary enuresis — previously dry children who start wetting again — requires medical evaluation to rule out urinary tract infection, new-onset diabetes, constipation, or an emotional trigger.

When to treat: treatment is generally recommended from age 7 if bedwetting is causing distress to the child (not the parent). Below 7, simple lifestyle advice and reassurance are first-line.

Evidence-based treatments: The enuresis alarm (bell-and-pad) is the most effective long-term treatment with cure rates of 60–70%. It works by conditioning the child to wake at the first sensation of wetness. Desmopressin (a synthetic form of ADH) reduces urine production at night and is effective for about 70% of children — particularly useful for sleepovers and travel. Both are available in Korea through paediatricians and GPs.

Lifestyle measures: limit fluids in the 1–2 hours before bed; regular toilet before sleep; avoid fizzy drinks and caffeine (including cola); address constipation (full bowels compress the bladder).