Nocturnal Enuresis

Bedwetting also known as Nocturnal Enuresis is when the bladder empties involuntarily during sleep in a child over the age of 5. It happens in approximately 1 in 5 children, and by age 6-7 years 1 in 10 children have night time accidents. It is not caused by laziness or attention seeking behaviour, and is often a complex condition which can cause distress for both the child and the family.

What causes bedwetting?

There are four main causes of bedwetting:

• Difficulty waking up to a full bladder
• Overactivity of the bladder at night
• Increased urine production at night
• Constipation

Bedwetting is not caused by:

• Immaturity
• Laziness
• Bad behaviour or being rebellious
• Drinking after dinner

When should we seek help?

It is recommended to seek support if:

• Bedwetting is bothering your child or affecting their emotional well‑being
• Your child expresses a wish to become dry at night
• Your child was previously dry and starts wetting the bed again
• Your child is not dry by the age of 7–8, as the problem may not resolve on its own.

Functional constipation in children or adolescents is more common than you think, affecting 25% of children at some point. If your child experiences ongoing stomach pain and difficulty going to the toilet, there’s a high likelihood they’re suffering from this condition. The good news is that treatment options are available for kids’ constipation following a diagnosis. 

What are the main symptoms of constipation?

Common signs of constipation in children include:

• Hard or painful bowel movements
• Small, infrequent stools
• Straining on the toilet
• Abdominal pain or discomfort
• Bloating
• Soiling or frequent poo accidents
• Increased urination
• Frequent urinary tract infections
• Wee accidents during the day
• Regression in toileting skills
• Delayed toilet training

What can cause constipation in children?

Constipation in children can be triggered by several factors, including:

• Toilet training
• Changes in routine (such as illness or holidays)
• Stressful events (for example starting school or family changes)
• Low dietary fibre intake
• Inadequate fluid intake
• Side effects of certain medications
• Ongoing bowel conditions that require further assessment

Some children may consciously or unconsciously hold back bowel movements. This can happen if:

• Toilets are not easily accessible
• A previous painful bowel movement has caused fear
• The child is busy playing and ignores the urge to go

Over time, this withholding behaviour can contribute to chronic constipation.

Children usually achieve daytime dryness by around 3½ years of age. However, every child develops at their own pace. There are many reasons why a child may experience daytime accidents, and it is important to explore these together in order to create an effective, individual treatment plan.

When a child has daytime accidents, this is not due to bad behaviour.
It is usually because the bladder is not functioning as it should.

Identifying the underlying cause is essential so that an appropriate strategy can be put in place to retrain the bladder. As there is often a close connection between bladder and bowel function, bowel habits are also carefully assessed to determine whether they are influencing bladder behaviour.

What Causes Daytime Wetting?

There can be a wide range of factors that can lead to daytime wetting. These include:

• Overactive Bladder

Children with an overactive bladder will find themselves going to the bathroom more often than is normal. Typically, a child should use the bathroom 4-7 times a day. More bathroom trips than that could indicate issues with bladder capacity leading to more peeing than is normal.

• Underactive Bladder (lazy bladder)

A child with an underactive bladder will find themselves not peeing as often as they should, going three times a day or less. This can cause the bladder to overfill, or lead to issues like a urinary tract infection or kidney infection that puts stress on the urinary system and causes involuntary release.

• Giggle incontinence

With this form of incontinence, children only lose urine when they laugh. They have no problems whatsoever when hopping or jumping. However, the psychological strain they experience is often very significant.

• Stress incontinence

Children lose urine when hopping, jumping or during other activities that place strain on the pelvic floor. This can have various causes, such as a tense pelvic floor that lacks coordination, or insufficient tension in the pelvic floor and a lack of contraction during exertion.

• Bad Bathroom Habits

Your child’s bathroom habits could also be contributing to daytime wetting issues. Sometimes children will struggle in toilet training and find themselves unable to notice their body’s natural bathroom cues. Putting off going to the washroom can cause issues with leakage and peeing before they have time to reach the toilet. Some children may also struggle with fully emptying the bladder, which can also lead to an increased number of accidents even after they’ve already gone.

• Other Medical Issues

Your child’s struggles with daytime wetting may also be a symptom of a larger medical issue. This is most common if your child is struggling with secondary diurnal enuresis, a form of daytime wetting that develops after your child seemingly had control of their bladder.

If your toilet-trained child has suddenly lost control of their bladder, it could be a result of a medical condition that is reducing their bladder control. This could be anything, from diabetes, to urinary tract abnormalities, to a psychological problem.

In these cases, a healthcare professional can determine the best course of treatment.

Pain During Toilet Time in Children

Children of all ages can sometimes experience pain when weeing or opening their bowels. This can be upsetting for both children and parents and may be a sign that something isn’t quite right. Many children feel embarrassed or unsure how to talk about these symptoms, so they may not always tell you what’s bothering them.

Signs to look out for

You might notice that your child:

• avoids going to the toilet
• complains of pain or discomfort when using the bathroom
• has tummy pain or bloating
• has more daytime or nighttime accidents
• seems irritable or has a reduced appetite

Common causes

Pain during toilet time can be linked to:

• Constipation, which can make bowel movements hard or painful
• Urinary tract infections (UTIs), causing burning, pain, or frequent urination
• Skin irritation or small tears, especially with hard stools
• Skin conditions or mild infections, such as vulvovaginitis or foreskin irritation

Why early support matters

When pain is left untreated, children may start to feel anxious about using the toilet, which can make symptoms worse over time. A calm, supportive approach and early professional guidance can help resolve these issues, reduce discomfort, and restore your child’s confidence.

Some children may experience pelvic pain, which can feel like a dull ache, spasms, or sharp, sudden pain in the pelvic area. In our clinic, we sometimes see children—particularly girls as young as six—who experience sharp vaginal or rectal pain, pelvic spasms, or ongoing aching.

These symptoms are especially common in young dancers and gymnasts and are often linked to pelvic floor muscle tension, tight abdominal muscles, or general muscle and movement imbalances.

Why it’s important to seek support

Pelvic pain should always be properly assessed, as early support can help prevent symptoms from becoming long‑term. A specialized physiotherapist can carefully evaluate what’s contributing to the pain and teach gentle, age‑appropriate strategies to help manage and reduce symptoms.

Treatment may include:

• education and reassurance
• gentle manual therapy
• advice on posture, movement, and daily habits
• simple lifestyle or dietary guidance where needed

Internal pelvic examinations are never performed on children. When appropriate, real‑time ultrasound may be used as a child‑friendly tool to support pelvic floor muscle awareness and biofeedback.