Bedwetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence.
For infants and young children, urination is involuntary. Wetting is normal for them. Most children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first while nighttime control comes later.

There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).
The cause is likely due to one or a combination of the following:

• The child cannot yet hold urine for the entire night.
• The child does not waken when his or her bladder is full.
• The child produces a large amount of urine during the evening and night hours.
• The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents are familiar with the "potty dance" characterized by leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.
• Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting. Common causes of secondary bedwetting include the following:
• Urinary tract infection:
• Diabetes:
• tructural or anatomical abnormality: An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence or other urinary problems that could show up as bedwetting.
• Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.
• Emotional problems
• Sleep patterns: Obstructive sleep apnea (characterized by excessively loud snoring and/or choking while asleep) can be associated with enuresis.
• Pinworm infection
• Excessive fluid intake.
• Bedwetting tends to run in families. Many children who wet the bed have a parent who did, too. Most of these children stop bedwetting on their own at about the same age the parent did.

• Wetting during the day
• Frequency, urgency, or burning on urination
• Straining, dribbling, or other unusual symptoms with urination
• Cloudy or pinkish urine, or blood stains on underpants or pajamas
• Soiling, being unable to control bowel movements (known as fecal incontinence or encopresis)
• Constipation

The health-care provider will ask many questions about the child's symptoms and about many other factors that can contribute to bedwetting. These include the following:

• The pregnancy and birth
• Growth and development, including toilet training (both urine and stool)
• Medical conditions. Specific attention is focused on the following:
  • Wetness of underwear: indicates day and nighttime enuresis
  • Palpating stool in the abdomen: indicates possible constipation or other obstruction
  • Excoriation of genital or vaginal area: possible scratching due to pinworms
  • Poor growth and/or high blood pressure: possible kidney disease
  • Abnormalities of the lower spine: possible spinal cord abnormalities
  • Poor urinary stream or dribbling: possible urinary abnormalities
• Medications, vitamins, and other supplements
• Family history if one or both parents were enuretic, approximately one-half to three-quarters of their offspring may also wet the bed. Identical twins are twice as likely to both be enuretic when compared to fraternal siblings.
• Home and school life: recent stress, how this problem is affecting the child and family, any attempts at therapy which have been tried
• Behavior
• Toilet habits: Record a voiding diary (daytime pattern and volume of urine, to determine bladder volume) and stool diary (to evaluate for constipation).
• Nighttime routines
• Diet, exercise, and other habits: Is there caffeine intake?

General principles
The many treatment options range from home remedies to drugs, even surgery for children with anatomical problems.

• Underlying medical or emotional conditions should first be ruled out.
• If there is an underlying condition, it should be treated and eradicated.
• If bedwetting persists once these steps are taken, however, there is considerable debate as to how and when to treat.

Treatment of uncomplicated bedwetting is not appropriate for children younger than 5 years of age.

• Because a majority of children 5 years and older spontaneously stop bedwetting without any treatment, many medical professionals generally choose to observe the child until age 7.
• The age at which to treat, then, depends on the attitudes of the child, the parents/caregivers, and the health-care provider.

Medical Treatment

Several drug therapies are available.

• These are typically reserved for children who have not stayed dry by using the alarms.
• Adults with bedwetting often take medications. They may have to stay on the medication indefinitely.
• The drugs do not work for everyone, and they can have significant side effects.
• The two drugs have been approved by the U.S. Food and Drug Administration (FDA) specifically for bedwetting are desmopressin (DDAVP) and imipramine (Tofranil). Others, which are not specifically approved for bedwetting, are oxybutynin (Ditropan, Urotrol) and hyoscyamine (Cystospaz, Levsin, Anaspaz).

Medical opinion is divided on using drugs to treat bedwetting. Many believe that, since the child will outgrow the bedwetting anyway, the risks outweigh the benefits of taking the drugs.

Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.

Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.

There really is no way to prevent bedwetting.