Bedwetting (Nocturnal Enuresis)
Bedwetting, also called nocturnal enuresis, is the involuntary passing of urine while asleep. It’s a very common issue, especially in young children, and is usually a developmental phase and not a serious medical problem.
Who Does It Affect?
- It’s normal for children under 5 years old to wet the bed occasionally.
- About 15% of children still wet the bed by age 5.
- About 5% of children still wet the bed by age 10.
- Most children naturally stop bedwetting by their teenage years.
If a child has never been consistently dry at night, this is called Primary Nocturnal Enuresis (this is the most common type). If a child has been dry for at least 6 months and then starts wetting the bed again, this is called Secondary Nocturnal Enuresis.
Why Does It Happen?
Bedwetting is rarely caused by stress or intentional behavior. It’s usually due to one or more of these factors:
- Too Much Urine Production at Night: The child’s body may not produce enough of the Anti-diuretic Hormone (ADH), which normally slows down urine production during sleep.
- Bladder Not Storing Enough: The bladder capacity might be smaller than average, or the bladder muscles might be overactive, causing contractions that release urine.
- Difficulty Waking Up: The child is a very deep sleeper and doesn’t wake up to the sensation of a full bladder.
Other Contributing Factors:
- Genetics: Bedwetting often runs in families. If one parent wet the bed, the child has a chance to also wet the bed; if both parents did, the chance the child will becomes even higher.
- Constipation: A full colon can press on the bladder and reduce its capacity.
- Underlying Medical Conditions (Rare): Conditions like a urinary tract infection (UTI) or diabetes can occasionally cause new-onset bedwetting (Secondary Enuresis).
When Should I See a Doctor?
It’s often best to talk to your child’s provider if:
- The bedwetting is causing distress or anxiety for the child (e.g., they are embarrassed or avoiding sleepovers).
- The child is age 7 or older and wetting the bed often (more than a couple of times a week).
- The child was dry for months and then started bedwetting again (Secondary Enuresis).
- There are new symptoms like burning during urination, daytime wetting, or sudden excessive thirst.
Simple Bedwetting Solutions (First Steps)
Before considering alarms or medication, try these simple, supportive lifestyle changes:
- Fluid Management: Limit drinks, especially those with caffeine or sugar, 1-2 hours before bedtime. However, do NOT restrict fluids during the day.
- Bathroom Routine: Make sure the child urinates twice before bed: once at the start of the bedtime routine, and a “final empty” right before lights out.
- Treat Constipation: Ensure the child is having regular, soft bowel movements.
- Be Supportive: Never punish or shame a child for bedwetting. This can worsen the problem. Use a positive approach, like rewarding non-wetting mornings with a sticker chart.
Advanced Treatments and When to Use Them
If simple changes don’t work, a provider may recommend:
1. Bedwetting Alarms (Long-Term Solution)
- How it works: A moisture sensor is placed in the child’s underwear or on the bed pad. When it detects the first drop of urine, a loud alarm sounds to wake the child.
- Goal: The alarm conditions the child’s brain to recognize the full bladder sensation and wake up on its own, even before the alarm goes off.
- Success: This treatment requires dedication (up to 12 weeks) but has a high long-term success rate (up to 70%).
2. Medications (Short-Term Solution)
Medication is generally reserved for special situations (like sleepovers, camps, or family trips) or after other methods have failed.
- Desmopressin (DDAVP): This is a synthetic version of the ADH hormone. It reduces the amount of urine the body makes at night. It’s effective while it’s being taken, but bedwetting can return once the medicine is stopped.
- Oxybutynin or Tolterodine: These may be used in combination with Desmopressin if an overactive bladder is the main issue.
Always discuss potential side effects and proper use with your child’s doctor before starting any medication.