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 (potty 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 bedwetting 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
Updated August 2009

	Incontinence Forums
Interstim therapy I have an Interstim system but will probably have to lose it. I am much improved with it but I still have a lot of symptoms. I think people forget just how bad they were without it. I have my favorite settings but after a while I think my body adjusts to ... (read more)
Interstim query Have any forum members had an interstim unit by Medtronic implanted? What luck, if any, have you had with it? And if successful, how long before you found the right setting for that success? So far, I haven't had the success my urologist anticipated af... (read more)
Tena for Men- shaped pads I have total bladder incontinence and partial bowel issues and I need something that is not noticeable and that fits me well, and I use the Attends with elastic waistband. The benefits of disposables is that it is very easy to do a quick change and simpl... (read more)
unexplained urgency You might want to submit your question to our nurse expert at: ask an incontinence nurse A nurse practitioner will respond and may have some suggestions for you. Good luck.... (read more)
Free yourself from diapers Do you experience urinary incontinence? Then you know that adult diapers are not good choices because they are not easy to conceal and can cause much embarrassment. However, many discreet and comfortable alternatives for men are available. âfex® is an ... (read more)