Nocturnal Enuresis

Updated: Jul 30, 2019

Nocturnal enuresis (bed-wetting) is a distressing disorder for parents and children.

It is more common in boys than in girls.

Parents are often unaware of the natural history of continence development and expect their child to be continent at a relatively early age. Children whose parents both have a history of enuresis as a child have a 77% chance of bed-wetting, 44% if only one parent has a positive history, and only a 15% if neither did.1

Parents seeking a nondrug, nonparent-intensive approach to bed-wetting seek a chiropractor’s advice. The chiropractor may perform the initial evaluation to determine known causes such as urinary tract infections or diabetes. The nonpathological, neurodevelopmental type of enuresis may be managed with conservative approaches. When these fail, referral for medication may be warranted.

Enuresis has been defined by the American Psychiatric Association as bed-wetting occurring in a child at age 5 years or above (and mental age of 4 years). The frequency is defined as two or more incontinent occurrences in a month between the ages of 5 and 6 or one or more occurrences after 6 in children who do not have an associated physical disorder such as urinary tract infection (UTI), diabetes, or seizures.2

At age 5 approximately 20% of children have enuresis, which decreases to 10% at age 10 and 1% at age 15.3,4

Enuresis is often categorized into primary and secondary causes. Primary causes include both functional and structural causes. Secondary enuresis is defined as the presence of a prior history of continence for more than a 6-month period. These patients often have a regression due to a stressful emotional event in the early years of life. Approximately 80% of childhood enuresis is the primary type.5,6

When not due to a structural cause, enuresis seems to follow a natural spontaneous remission. This natural history must be taken into account when it appears that a child is responding to a specific therapy.

1. Friman PC. A preventative context for enuresis. Pediatr Clin North Am. 1986;33:871-876

2. Diagnostic and Statistical Manual of Mental Disorders. 3rd rev, ed. Washington, DC American Psychiatric Association; 1983;84-85

3. Mann EM. Nocturnal enuresis. West J Med. 1991;155:520-521

4. Rosenfield J, Jenkins GR. The bed-wetting child: current management of a frustrating problem. Postgrad Med. 1991;89:63-70

5. Himsi KK, Hurwitz RS. Pediatric urinary incontinence. Urol Clin North Am. 1991;18:283-293

6. Priman PC, Warzak WJ. Nocturnal enuresis: a prevalent, persistent, yet curable parasomnia. Pediatrician. 1990:17:38-45