Working out what is happening

All children and young people with bedwetting and their parents or carers should be offered an assessment that is suitable for the family's needs and circumstances.

Questions the healthcare team should ask

The healthcare team should ask questions about the following topics:

  • Bedwetting, such as did it start in the last few days or weeks, how long has it been a problem for, how often does it happen, at what time of night, does there seem to be a large amount of urine, does the child or young person wake up and could something have acted as a trigger.

  • Daytime problems, such as needing to pass urine frequently (more than seven times a day) or infrequently (fewer than four times a day), needing to pass urine urgently, wetting during the day, straining when passing urine, a weak urinary stream (dribbling) or pain when passing urine and whether daytime problems occur only in certain situations.

  • Fluid intake, such as how much is the child or young person drinking during the day and are they drinking less because of concerns about the bedwetting or to avoid having to use particular toilets.

  • Toilet use, such as avoiding particular toilets (for example, school toilets) or using the toilet more or less frequently than other children.

The healthcare team might ask for a record to be kept of the bedwetting, daytime urinary problems, drinks and toilet use over time to help work out what may be causing the problem and the best way to treat it.

Tests, assessment and referral

A urine test is not normally needed unless:

  • the bedwetting started in the last few days or weeks

  • there are other daytime urinary problems or

  • another health problem is suspected (a urinary infection or diabetes in particular).

A healthcare professional should assess whether the child or young person has other problems that may cause or be related to bedwetting, in particular constipation and/or soiling; developmental, attention or learning difficulties; diabetes; behavioural or emotional problems; and family problems.

If a healthcare professional suspects type 1 diabetes, the child or young person should be referred to a diabetes care team on the same day, in line with the NICE guideline on diabetes (type 1 and type 2) in children and young people. If urinary tract infection or constipation and/or soiling are suspected, the child or young person should receive the care outlined in the NICE guidelines on urinary tract infection in children and constipation in children and young people.

Further assessment, tests or referral may be offered for severe daytime urinary problems; previous urinary infections; physical or neurological problems; development, attention or learning difficulties; and behavioural, emotional or family problems.

If the healthcare team suspects an emotional or behavioural problem, a healthcare professional with psychological expertise may be involved in the child or young person's care.

If there are daytime urinary problems as well as bedwetting, the healthcare team may consider it best to investigate and treat the daytime problems first if they are the main problem.

Assessment for children under 5 years

The healthcare team should ask you whether toilet training has been attempted, and if not, discuss the reasons for this with you.

If your child is between 2 and 5 years, and is able to use the toilet but still wetting or soiling themselves during the day as well as the night, your healthcare team may want to check if there is a particular medical cause.

Your child should be assessed for constipation as it is a common cause of bedwetting and soiling in children.

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