Bedwetting clinic, stepwise and kind.

Prices vary by clinic (GOSH Private Paediatric Urology, Evelina Children's Private, HCA Portland Paediatric Urology and independent BAPU-registered consultants) and by whether an ultrasound or dietitian input is needed.

1. 01

   Before

   You send a short history

   A confidential form: your child's age, whether they have ever been dry at night, any daytime wetting, bowel habit and any recent stressors.

2. 02

   Before

   We come back with a plan

   Within one working day we suggest the right first clinic (paediatric urologist or specialist continence nurse), a bladder diary and a stool chart to start straight away.

3. 03

   Before

   Bladder and bowel diary

   A week of drinks, voids, wet and dry nights and Bristol Stool Chart entries. We provide the templates. This drives every treatment decision.

4. 04

   In clinic

   The clinic assessment (45 minutes)

   Full history, examination, spinal skin check, urinalysis and a bladder ultrasound if voiding dysfunction is suspected. Diabetes, UTI and constipation are excluded.

5. 05

   In clinic

   A written stepwise plan

   Education and lifestyle first, treat constipation with a Movicol regimen, then either an enuresis alarm or a desmopressin trial depending on the pattern.

6. 06

   After

   Alarm or desmopressin, supported

   If an alarm, a 6 to 8 week course with weekly nurse contact. If desmopressin, a 3 month course reviewed at 4 weeks. On-demand doses for sleepovers and camp.

7. 07

   After

   Review, escalate or discharge

   Refractory cases go to combined alarm plus desmopressin, then anticholinergics for daytime symptoms. Imipramine is a last resort and rarely used.

• Primary nocturnal enuresis (PNE)

  Never dry at night, age 5 or older, no daytime wetting. Around 10% of 7 year olds and 5% of 10 year olds. Very treatable.

• Secondary enuresis (regression)

  Previously dry for 6 months or more, now wetting. Always look for a trigger: constipation, UTI, diabetes, a new stressor, or sleep-disordered breathing.

• Small nocturnal bladder capacity

  The bladder empties before it can hold a whole night. Bladder training and daytime hydration help. Anticholinergics if daytime urgency coexists.

• Nocturnal polyuria (low ADH pattern)

  The child produces too much urine at night. This is the classic desmopressin-responsive pattern - a synthetic ADH given 60 minutes before bed.

• Deep sleep, high arousal threshold

  The bladder signal never wakes the child. This is the classic alarm-responsive pattern - the alarm conditions arousal over 6 to 8 weeks.

• Constipation (very common driver)

  A loaded rectum crowds the bladder and worsens both day and night wetting. Treat with Movicol first: bedwetting often improves before any alarm or medicine.

• Strong family history

  If one parent wet the bed, the child has a 40% chance; if both, around 75%. Genetics are reassuring - not a reason to delay treatment.

• Red flags: daytime wetting, snoring, back

  Daytime wetting, heavy snoring, spinal skin dimples or tuft, or a sudden regression need paediatric urology review and, sometimes, MRI of the spine.

• Your child is not to blame

  Bedwetting is a physiological problem, not laziness or a psychological problem. Punishment makes it worse. Every letter and every conversation we send reflects that.

• Rule out the treatable causes first

  Urinalysis for infection and diabetes, a bowel history and stool chart for constipation, a spinal examination and, if there is snoring, an OSA screen.

• Constipation is the commonest driver

  A loaded rectum presses on the bladder. A proper macrogol regimen for 4 to 12 weeks resolves the bedwetting in a meaningful proportion of children on its own.

• Alarms need family buy-in

  The alarm wakes the child (and a parent) at the first drop for 6 to 8 weeks. It works when the family is ready. We check readiness before starting.

• Desmopressin: fluid restriction matters

  No fluid in the hour before or the 8 hours after dosing. Hyponatraemia is rare but real. We give clear written rules and skip doses on sick days.

• Sleepovers and school camp

  On-demand desmopressin for one-off nights is a game changer. We prescribe a small supply and a written plan that a teacher can follow discreetly.

• Imipramine is a last resort

  Only for older refractory children, with an ECG, and locked in a childproof container. Never a first or second-line drug in our clinic.

• When to refer to paediatric urology

  Daytime wetting, mixed day and night wetting, failure of first-line, structural or spinal concern, or significant family psychological impact.

• Red flags after starting treatment

  New daytime wetting, severe headache or vomiting on desmopressin, blood in the urine, back pain or leg weakness - contact us or A&E the same day.