Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don’t despair. Bed-wetting isn’t a sign of toilet training gone bad. It’s often just a normal part of a child’s development.
Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 7 isn’t a concern. At this age, your child may still be developing nighttime bladder control.
If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting.
While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying disease. In fact, a true organic cause is identified in only a small percentage of children who wet the bed. However, this does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient.
There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months).
In general, primary bedwetting probably indicates immaturity of the nervous system. A bedwetting child does not recognize the sensation of the full bladder during sleep and thus does not awaken during sleep to urinate into the toilet.
The cause is likely due to one or a combination of the following:
- The child cannot yet hold urine for the entire night.
- The child does not waken when his or her bladder is full.
- The child produces a large amount of urine during the evening and night hours.
- The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents are familiar with the “potty dance” characterized by leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.
Dryness at night usually follows achievement of continence by day. During the second year of life, children start to develop the ability to relax the external urethral sphincter voluntarily and to initiate voiding, even in the absence of the desire to void. By approximately age 4 years, all children with normal bladder function should have acquired this ability.
Bed-wetting is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.
Most kids are fully toilet trained by age 5, but there’s really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.
WHEN TO SEE A DOCTOR
Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.
Consult your child’s doctor if:
- Your child still wets the bed after age 7
- Your child starts to wet the bed after a few months or more of being dry at night
- Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring
The health-care provider will ask many questions about the child’s symptoms and about many other factors that can contribute to bedwetting. These include the following:
- The pregnancy and birth
- Growth and development, including toilet training (both urine and stool)
- Medical conditions. Specific attention is focused on the following:
- Wetness of underwear: indicates day and nighttime enuresis
- Palpating stool in the abdomen: indicates possible constipation or other obstruction
- Excoriation of genital or vaginal area: possible scratching due topinworms
- Poor growth and/or high blood pressure: possible kidney disease
- Abnormalities of the lower spine: possible spinal cordabnormalities
- Poor urinary stream or dribbling: possible urinary abnormalities
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 the parent stopped bed-wetting.
If your child isn’t especially bothered or embarrassed by an occasional wet night, traditional home remedies may work well. However, if your grade schooler is terrified about wetting the bed during a sleepover, he or she may be more motivated to try additional treatments. The child’s and parents’ motivation can impact the selection of treatment and its success.
If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment.
These small, battery-operated devices — available without a prescription at most pharmacies — 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 and wake the child.
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 16 weeks to enjoy dry nights. Moisture alarms are effective for many children, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does. These devices are not typically covered by insurance.
As a last resort, your child’s doctor may prescribe medication to stop bed-wetting. Certain types of medication can:
- Slow nighttime urine production. The drug desmopressin (DDAVP, others) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. But drinking too much liquid with the medication can cause problems with low sodium levels in the blood and the potential for seizures. So drinking only 8 ounces (237 milliliters) of fluids with and after the medication is recommended. Don’t give your child this medication if he or she has a headache, has vomited or feels nauseated. Desmopressin also may be used in short-term situations, such as going to camp.
According to the Food and Drug Administration, nasal spray formulations of desmopressin (DDAVP Nasal Spray, DDAVP Rhinal Tube, others) are no longer recommended for treatment of bed-wetting due to the risk of serious side effects.
- Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) may help reduce bladder contractions and increase bladder capacity. This medication is usually used in combination with other medications and is generally recommended only when other treatments have failed.
Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn’t cure the problem. Bed-wetting typically resumes when medication is stopped.