My seven year old son has never been dry at night. My friend says he must have some emotional problem and I should take him to counseling. His father wet the bed until he was 9 or 10 years old. Could there be a genetic link? Should I take my son to counseling or is there other treatment? It's becoming a real problem for the entire family and I don't know what to do.

Contrary to popular opinion, bed-wetting is a very common problem. It affects somewhere between five and six million children. Unfortunately, most of those kids and their parents feel that something must be emotionally wrong; that they must be suffering from low self-esteem, trauma, or stress in their lives. The great news is that, in the vast majority of cases, this is not true!

Bed-wetting, or nocturnal enuresis, can be divided into two types: primary nocturnal enuresis and secondary nocturnal enuresis. These two types are very different in their causes and treatments.

In primary nocturnal enuresis, children have never achieved complete nighttime control - always wetting at least two times a month. Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.

In secondary enuresis, the key is finding out exactly what has changed. There might be a new psychological stress such as a divorce, a move, or a death in the family. It might be something physical: the onset of a urinary tract infection or diabetes, for example. It might be a situational change - perhaps altered eating, drinking, or sleeping habits. Clearly, something has changed. The first step in solving the problem is identifying that something.

The great majority of bed-wetting children are primary enuretics. For primary enuretics, the cause is decidedly NOT stress or behavioral concerns. Research has shown that primary nocturnal enuresis is often inherited. If both parents were bed-wetters, 77% of their children will be. If only one parent was, 44% of their offspring will be. If neither parent wet the bed, only about 15% of their children will wet the bed. With primary nocturnal enuresis, one almost always finds another relative who was a bed wetter. This corresponds to what is called an autosomal dominant inheritance pattern.

In recent years, researchers have identified an association with bedwetting and two genes named ENUR1 and ENUR2. The ENUR1 gene is located on the 13th chromosome while ENUR2 is found on chromosome 12. In studying certain families with primary nocturnal enuresis, researchers discovered that members who wet the bed were more likely to have the ENUR1 or ENUR2 gene than those who did not. More recently, the possibility of a third primary nocturnal enuresis-related gene (ENUR3) on chromosome 22 has also been uncovered. Presumably these genes affect either whether children will need to urinate at night or how easily they can wake up when their bladders are full.

If your child has primary nocturnal enuresis, I would not take the child to counseling to solve the problem. Beginning at age seven, primary nocturnal enuresis resolves on its own at a rate of 15% per year. It is quite likely that if nothing were done, your child would wet the bed until about the same age as his father. There is no reason to wait until age nine, since effective and safe therapies are now available. The best way to pursue help is to talk with your pediatrician. If you find that for some reason she or he is not able to get your child dry quickly and effectively, I would call the closest Children's Hospital to find out who treats bed-wetting issues.