Table 1

Bedwetting history and possible interpretationsa

Findings from historyPossible interpretation
Large volume of urine in the first few hours of nightTypical pattern for bedwetting only
Variable volume of urine, often more than once a nightTypical pattern for children and young people who have bedwetting and daytime symptoms with possible underlying overactive bladder
Bedwetting every nightSevere bedwetting, which is less likely to resolve spontaneously than infrequent bedwetting
Previously dry for >6 monthsBedwetting is defined as secondary
Daytime frequency/urgency/wetting; abdominal straining or poor urinary stream; pain passing urineAny of these may indicate the presence of a bladder disorder such as an overactive bladder or, more rarely (when symptoms are very severe and persistent), an underlying urological disease
ConstipationA common comorbidity that can cause bedwetting and requires treatment (see Constipation in Children and Young People, NICE clinical guideline 99)
SoilingFrequent soiling is usually secondary to underlying faecal impaction and constipation, which may have been unrecognised
Inadequate fluid intakeMay mask an underlying bladder problem, such as overactive bladder disorder, and may impede the development of an adequate bladder capacity
Behavioural and emotional problemsThese may be a cause or a consequence of bedwetting. Treatment may need to be tailored to the specific requirements of each child or young person and family
Family problemsA difficult or ‘stressful’ environment may be a trigger for bedwetting. These factors should be addressed alongside the management of bedwetting
Practical issuesEasy access to a toilet at night, sharing a bedroom or bed, and proximity of parents to provide support are important issues to take into account and address when considering treatment, especially that with an alarm
  • a Taken from NICE guideline CG111 on nocturnal enuresis.2