Nocturnal enuresis (NE), also informally called bedwetting, is involuntary urination while asleep after the age at which bladder control usually begins.

Treatments range from behavioral therapy, such as bedwetting alarms, to medication,[8][9] such as hormone replacement, and even surgery such as urethral dilatation.

[6] Treatment guidelines recommend that the physician counsel the parents,[10] warning about psychological consequences caused by pressure, shaming, or punishment for a condition children cannot control.

[11][12][13] A review of medical literature shows doctors consistently stressing that a bedwetting child is not at fault for the situation.

[15] Bedwetters face problems ranging from being teased by siblings, being punished by parents, the embarrassment of still having to wear diapers, and being afraid that friends will find out.

As mentioned below, current studies show that it is very rare for a child to intentionally wet the bed as a method of acting out.

[citation needed] Medical literature states, and studies show, that punishing or shaming a child for bedwetting will frequently make the situation worse.

[18] In Korea and in small parts of Japan, there is a folk tradition whereby bedwetters are made to wear a winnowing basket on their head and sent to ask their neighbors for salt.

A European study estimated that a family with a child who wets nightly will pay about $1,000 a year for additional laundry, extra sheets, diapers, and mattress replacement.

[27] The etiology of NE is not fully understood, although there are three common causes: excessive urine volume, poor sleep arousal, and bladder contractions.

Differentiation of cause is mainly based on patient history and fluid charts completed by the parent or carer to inform management options.

[30] These first two factors (aetiology and genetic component) are the most common in bedwetting, but current medical technology offers no easy testing for either cause.

At about sunset each day, the body releases a minute burst of antidiuretic hormone (also known as arginine vasopressin or AVP).

Four- and five-year-olds develop an adult pattern of urinary control and begin to stay dry at night.

Bedwetting becomes a disorder when it persists after the age at which bladder control usually occurs (4–7 years), and is either resulting in an average of at least two wet nights a week with no long periods of dryness or not able to sleep dry without being taken to the toilet by another person.

[14] Secondary enuresis occurs after a patient goes through an extended period of dryness at night (six months or more) and then reverts to night-time wetting.

[56] Psychologists are usually allowed to diagnose and write a prescription for diapers if nocturnal enuresis causes the patient significant distress.

[57] Psychiatists may instead use a definition from the DSM-IV, defining nocturnal enuresis as repeated urination into bed or clothes, occurring twice per week or more for at least three consecutive months in a child of at least 5 years of age and not due to either a drug side effect or a medical condition.

The following options apply when the bedwetting is not caused by a specifically identifiable medical condition such as a bladder abnormality or diabetes.

Only a small percentage of bedwetting is caused by a specific medical condition, so most treatment is prompted by concern for the child's emotional welfare.

[61] Other treatment methods include the following: Doctors frequently consider bedwetting as a self-limiting problem, since most children will outgrow it.

[78] In the first century B.C., at lines 1026-29 of the fourth book of his On the Nature of Things, Lucretius gave a high-style description of bed-wetting:[79] An early psychological perspective on bedwetting was given in 1025 by Avicenna in The Canon of Medicine:[81] Psychological theory through the 1960s placed much greater focus on the possibility that a bedwetting child might be acting out, purposefully striking back against parents by soiling linens and bedding.