The last stage of bladder control in sleep appears to be particularly difficult to achieve for a significant minority of
children from 4 to 5 years of age and beyond. In fact, bedwetting (nocturnal enuresis) may be regarded as the
most chronic and prevalent of all childhood disorders.

Organic causes and complications of bladder and bowel incontinence are almost always sought but rarely found.
While maturational and hereditary mechanisms are undoubtedly implicated, they clearly interact with personal-
societal concerns and toilet training procedures. The effectiveness of the various surgical, biochemical, and
behavioral conditioning interventions attests to the highly interactive nature of enuresis or Encopresis. The
visibility of enuretic and encopretic symptoms lends an objectivity to clinical assessment procedures which is not
generally found for other functional disorders. This realization, the robustness of modern medical and behavioral
sciences, and the centuries old concerns surrounding soiling promise increased freedom from the problem of
urinary and fecal incontinence.

Loss of bladder control at night, bedwetting, is technically known as nocturnal enuresis. A daytime failure to
reliably hold and release urine in an appropriate place is called diurnal enuresis . In the course of normal
development we gain control over our bodily functions in a typically reliable sequence. First, we gain bowel
ontrol overnight in sleep and then in the daytime. Bladder control comes next for the day and, finally, over the
course of the nighttime while asleep. Bladder control in sleep is typically the last eliminative function to come
under control and it is diagnosable from age 4 years on. It occurs with surprising frequency. The pediatric
community usually assumes and assures parents that their child will grow out of it. I strongly disagree with this
passive attitude. I advocate for applying a rational treatment as soon as possible, which beats the natural
cure or growing out of it rates of only 1 in 4 to 1 in 7 odds of becoming dry in any given year after age 4. The
chances of drying up in the next year actually decrease as children grow older. Why live with it?