Bed-Wetting

Soggy sheets and pajamas—and an embarrassed child—are a familiar experience for many parents. But don’t despair. Bed-wetting doesn’t mean that your toilet training skills are hopeless. It’s often just a developmental stage that, with patience and understanding, both child and parents will get through.

Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 6 or 7 isn’t cause for concern. Before this age, nighttime bladder control simply may not be established.

Most kids are fully toilet trained by age 4, but there’s really no target date for developing complete bladder control. By age 5, bed-wetting remains a problem for about 15 percent of children. Between 8 and 11 years of age, fewer than 5 percent of youngsters are still wetting the bed.

Most children outgrow bed-wetting on their own—but some need a little help. In other cases, bed-wetting may indicate an underlying condition that needs medical attention.

Consult your child’s doctor if:

  • Your child still wets the bed after age 6.
  • Your child starts to wet the bed after a period of being dry at night.
  • The bed-wetting is accompanied by painful urination, unusual thirst, pink urine or snoring.

Understanding the Causes

No one knows for sure what causes bed-wetting, but various factors may play a role. It may be helpful, for a worried parent, to understand that some causes may be natural and beyond your control:

  • Small bladder. Your child’s bladder may not be developed enough to hold urine produced during the night.
  • Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep—especially if your child is a deep sleeper.
  • Hormone imbalance. During childhood, some kids don’t produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
  • Stress. Stressful events—such as becoming a big brother or sister, starting a new school or sleeping away from home—may trigger bed-wetting.
  • Urinary tract infection.
  • Sleep apnea. With this condition, the child’s breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. This sleep-disrupting condition may be related to bed-wetting.
  • Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of diabetes.
  • Chronic constipation. A lack of regular bowel movements may lead to reduced bladder capacity.
  • Anatomical defect. Rarely, bed-wetting is related to a defect in the child’s neurological system or urinary system.

Several factors have been associated with an increased risk of bed-wetting, including:

  • Gender. Bed-wetting can affect anyone, but it’s more common in boys.
  • Family history. If both of a child’s parents wet the bed as children, their child has an 80 percent chance of wetting the bed, too.
  • Attention deficit hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.

Although frustrating, bed-wetting without a physical cause doesn’t pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.

Rashes on the bottom and genital area may be an issue as well—especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.

Working Toward a Solution

  • Limit fluid intake in the evening.
  • Avoid beverages and foods with caffeine.
  • Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it’s OK to use the toilet during the night if needed. Use small night lights so that your child can easily find the way between the bedroom and bathroom.
  • Encourage regular urination throughout the day. During the day and evening, suggest that your child urinate once every two hours, or at least enough to avoid a feeling of urgency.
  • Treat constipation.

Most children outgrow bed-wetting on their own. If there’s a family history of bed-wetting, your child will probably stop bed-wetting around the age you or your spouse stopped bed-wetting.

If you choose to visit your child’s doctor, your child generally will be your doctor’s guide to the level of necessary treatment. If your child isn’t especially bothered or embarrassed by an occasional wet night, less aggressive treatments may be all that’s needed. However, if your grade-schooler is terrified about wetting the bed on a sleepover, he or she may be more motivated to try additional treatments.

One option is to try a moisture alarm. Moisture alarms are small, battery-operated devices that connect to a moisture-sensitive pad on your child’s pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate—in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes at least two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, carry a low risk of relapse or side effects and may provide a better long-term solution than medication does.

If all else fails, your child’s doctor may prescribe medication to stop bed-wetting. Medications can have several effects:

  • Slow nighttime urine production
  • Calm the bladder
  • Change a child’s sleeping and waking pattern

Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn’t actually cure the problem. Bed-wetting typically resumes when the medication is stopped.

Finding Ways to Cope, While Positively Supporting Your Child

It’s important to remember that children don’t wet the bed to irritate their parents! Because your child’s bed-wetting is involuntary, it’s illogical to punish wet nights or reward dry nights. Try to be patient as you and your child work through the problem together:

  • Be sensitive to your child’s feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past.
  • Plan for easy cleanup. Cover your child’s mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy.
  • Enlist your child’s help. Perhaps your child can rinse his or her wet underwear and pajamas or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
  • Celebrate effort. Don’t punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents.

With reassurance, support and understanding, your child can look forward to dry nights ahead.

Dr. Arkadiy Tkachev is a board-certified family medicine physician. Dr. Tkachev treats the whole family, from newborns to seniors, at PacMed’s Renton clinic location. Click here to learn more about Arkadiy Tkachev, MD.

Arkadiy Tkachev, MD

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