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physiology of bedwetting

by Diane K. Newman, RNC, MSN, CRNP, FAAN

The development of bladder (urinary) continence in a child is dependent on three factors, all maturing concomitantly:

• Development of normal bladder capacity
• Mature functioning of the urethra and sphincter
• Development of the brain and nerve pathways that control voluntary voiding
  

We are all born incontinent; an infant's bladder empties involuntarily depending on stimuli and urine volume. As a toddler's bladder, pelvic nerves and bladder control center in the brain develop, voiding gradually becomes voluntary. Bladder capacity increases one ounce (30ml) each year during the first eight years of life and girls generally have a larger capacity than boys do.

Bladder control during the day is usually achieved between the ages of two and three; nighttime control is mastered by age four, although girls are successfully toilet-trained earlier than boys. Many children achieve daytime continence while still lacking bladder control during the night.

Parents need to understand if their child is wetting the bed beyond the age of six, they generally need only to wait longer for their child's bladder to mature. Nerve pathways between the pelvis and brain may not yet be fully developed in these children or they may still have small bladders. Some children sleep so soundly that they don't wake up even when their bladder is full and needs to be emptied. A physical or medical problem such as diabetes or a urinary tract infection can also cause the bedwetting, so if it persists in your child past age six, the parent should discuss the situation with the child's pediatrician.

References

1. Berry, AK. Helping Children with Nocturnal Enuresis. AJN. 2006;106(8):58-65.

Posted August 2006

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