Enuresis is a term used for involuntary urination. Children gain bladder control in 2-3 years for the mornings and 3-4 years for the nights. Boys gain this control in a later period than girls. However, in the puberty, it occurs in the same frequency for both of the sexes. In conditions and institutions of low socio-economy and education, the children experience it more frequently.


In order to diagnose an enuresis, the following features must exist:

  • The child needs to be older than 5,
  • There needs to be a repetitive involuntary urination to his/her underwear or to the bed,
  • This condition needs to be going on for 3 months and at least twice in a week,
  • The functionality of the child about the daily vital activities, social orientation and peer relationships need to be effected badly,
  • This condition needs to exist independent from another medical disease.



  1. Familial Tendency: %70-75 of the enuretic children has first degree relatives who have a similar story.
  2. Problems about Physiology of Bladder: Lowness of the functional bladder capacity, contraction and evacuation before the bladder is full, urination frequently but little in the mornings, contraction at the bladder during sleep, the strength of urethral sphincter being lower than normal.
  3. Developmental problems: Existence of developmental delay
  4. Hormonal Factors: Delay of the increase in ADH (anti-diuretic hormone) on enuretics which is normally seen at nights.


  1. Toilet training: Some examples are early start of toilet training, strict toilet training, inappropriate and careless behavior of the parents. It is more convenient to start the toilet training between the ages 1,5-2,5. In this period, the child is taken to the toilet in reasonable time intervals and is supported to make it to the appropriate place. The child can be put into bed without any diaper as soon as he/she starts telling that he/she needs to go to the toilet.
  2. Hard living conditions: Important changes and losses in the family, deaths, separations, divorces, conflicts, diseases, failure at school, birth of a sibling.


It is rare that the treatment starts at ages 5 or 6. Before these ages, the parents who have urinary incontinent child are consulted and informed to come up with a solution. However, the ones who are older than 6 need more active diagnosis and treatment process. Selection of the method of treatment varies according to the causal factors, age of the child, frequency of the problem, results and the urgency of the situation.

1. Motivation Techniques:

A- Keeping track and rewarding: The child marks on the calendar the days of dry or wet nights. The ones who don’t know how to write can put symbols of sun or rain, and the ones who know can show it by writing. These signs must definitely be put by the child himself/herself. In the weekly controls, the child is rewarded if the dry days are more (by playing with the child the game that he/she wants for example). Rewards with emotional content (saying well done, hugging, caressing his/her hair, exaggerating his/her success etc.) and tangible rewards (toys, food, etc.) are also more effective.

B- Liquid limitation and wakening at nights: Putting a limit to the liquid taken after dinner (tea, coke, watermelon etc.) may lower the urine level at sleep.

2. Bladder Gymnastic:

A- Bladder Education Exercises: The child is asked for not drinking too much liquid (up to 500 cc) every day at a certain time, usually mornings or after school and delaying urination as much as possible. The volume eliminated from the body is measured several times in a week. The purpose is to reach a bladder capacity that holds enough urine.

B- Sphincter Education Exercises: While the child is urinating in the morning, he/she is asked to stop immediately and do it again.

3. Conditioning (Alarm machine): There are alarms that activates itself when the child is not urinating enough. The bell rings when the child starts urinating. He/she wakes up, turns the key off and gets up to empty his/her bladder.

4. Medication: After an evaluation by the experts of Child Health and Diseases (Pediatry), Pediatric Surgery and Child’s Mental Health, it is needed to be organized according to the causes and controlled regularly.