Many children wet their bed. In fact, it is so common that it is often considered a normal part of growing up. In most cases, the cause of bedwetting is physical and not the child's fault. Their bladder might be too small. Or the amount of urine produced overnight is too much for the bladder to hold. As a result, the bladder fills up before the night is over. Some children sleep too deeply or take longer to learn bladder control. Children don't wet the bed on purpose.
Despite it most often being normal, bedwetting can be embarrassing for the child and frustrating for the parents. Just keep in mind that many children experience occasional bedwetting, and treatment, if needed, is available for most children who have difficulty controlling their bladder.
Bedwetting, or sleepwetting, is known medically as nocturnal enuresis or nighttime incontinence. It is a medical problem, not a behavior problem. Scolding and punishment will not help a child stay dry. Most children grow out of bedwetting naturally.
How Common Is Bedwetting?
Bedwetting is very common before the age of 6. As children grow up, it usually gets better on its own. About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of bedwetting. It is rare in adulthood.
Wetting at night is about twice as common in boys as in girls.
Understanding the Urinary System
Urination, or voiding, is a complex activity. The bladder is a balloon-like organ that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, which is the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord, and the brain.
The bladder has two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder, that automatically stay closed to hold the urine in, and automatically relax when the detrusor contracts, to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.
A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system matures. The child's brain begins to get messages from the filling bladder, and begins to send messages to the bladder to keep it from automatically emptying, until the child decides it is the time and place to void.
Failures in this control mechanism result in incontinence. Reasons for this failure range from simple to complex.
Experts don't know the exact cause of bedwetting. Young people who experience bedwetting are usually physically and emotionally normal. These experts do think, however, that a combination of factors probably results in most cases of bedwetting. These factors include:
- Slower physical development
- Overproduction of urine at night
- Anxiety
- Genetics
- Medical conditions or structural problems.
Slower Physical Development
Between the ages of 5 and 10, bedwetting may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body's alarms that signal a full or emptying bladder. This form of
urinary incontinence usually fades away as the bladder grows, and the natural alarms become operational.
Excessive Output of Urine During Sleep
Normally, the body produces a hormone that can slow the production of urine. This hormone is called antidiuretic hormone, or ADH. The body normally produces more ADH at night, so that the need to urinate is lower. If the body doesn't produce enough ADH at night, the production of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, then bedwetting will occur.
Anxiety
Experts suggest that
anxiety-causing events, occurring in the lives of children ages two to four, might lead to bedwetting, before the child achieves total bladder control. Anxiety experienced after age four might lead to wetting after the child has been dry for a period of six months or more. Such events can include:
- Angry parents
- Unfamiliar social situations
- Loss of a loved one
- Problems at school
- Overwhelming family events, such as the birth of a brother or sister.
Bedwetting itself is an anxiety-causing event. Strong bladder
contractions, leading to leakage in the daytime, can cause embarrassment and anxiety, that lead to wetting at night.
Genetics
Certain inherited genes appear to contribute to bedwetting. In 1995, Danish researchers announced they had found a site on human chromosome 13 that is responsible, at least in part, for bedwetting.
If both parents were bed-wetters, a child has an 80 percent chance of being a bed-wetter also. Experts believe that other, undetermined genes may also be involved in incontinence. If only one parent has a history of bedwetting, the child has about a fifty-fifty chance of having the problem. Some children wet the bed even if neither parent ever did.
Obstructive Sleep Apnea
Bedwetting may be one sign of another condition called obstructive
sleep apnea, in which the child's breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. Other symptoms of this condition include:
- Snoring
- Mouth breathing
- Frequent ear and sinus infections
- Sore throat
- Choking
- Daytime drowsiness.
In some cases, successful treatment of this breathing disorder may also resolve the associated bedwetting.
Structural Problems
Finally, a small number of cases of bedwetting are caused by physical problems in the urinary system, in children. Rarely, a blocked bladder or urethra may cause the bladder to overfill, and leak. Nerve damage, associated with the birth defect
spina bifida, can cause bedwetting. In these cases, the bedwetting can appear as a constant dribbling of urine.
Does Bedwetting Improve on Its Own?
While bedwetting can be frustrating for the child and parents, most of the time a trip to the doctor is not needed. If your child is younger than five, don't worry about bedwetting. Many children do not stay dry at night until age seven.
The fact is that most children outgrow wetting the bed. This can happen for a variety of reasons:
- Bladder capacity increases
- Natural body alarms become activated
- An overactive bladder settles down
- Production of ADH becomes normal
- The child learns to respond to the body's signal that it is time to void
- Stressful events or periods pass.
Also, a single episode of bedwetting should not cause alarm, even in an older child.
Dealing With Bedwetting
There are some things that parents can try if their child has wetting at night. Some of these suggestions include:
- Try skipping drinks before bedtime.
- Avoid drinks with caffeine, like colas or tea. These drinks speed up urine production.
- Give your child one drink with dinner. Explain that it will be the last drink before going to bed.
- Make sure your child uses the bathroom just before bed.
Many children will still wet the bed, but these steps are a place to start.
Your child may feel bad about wetting the bed. Let your child know he isn't to blame. Let her help take off the wet sheets and put them in the washer, but don't make this a punishment. Be supportive. Praise your child for dry nights.
Be patient. Most children grow out of bedwetting. Some children just take more time than others.
Visiting Your Healthcare Provider
If your child is seven years old or older and wets the bed more than two or three times in a week, a doctor may be able to help. If both day and night wetting occur after age five, your child should see a healthcare provider before age seven.
Some other reasons to see your child's doctor if he or she is wetting their bed at night include:
- Your child complains of a burning sensation when urinating
- He or she starts wetting the bed after being consistently dry for at least six months.
At the visit, the healthcare provider will ask questions about your child's health and the wetting problem. Your child will likely be asked for a urine sample. The doctor uses the sample to look for signs of infection. By testing the reflexes in the child's legs and feet, the doctor can check for nerve damage. Sometimes bedwetting is a sign of
diabetes, a condition that can cause frequent urination.
If your child has an infection, the doctor can prescribe medicine. In most cases, the doctor finds that the child is normal and healthy. If your child is basically healthy, there are a variety of ways to help your child stop wetting the bed.
Treatment for Bedwetting
Depending on the situation, treatments for bedwetting can include:
- Bladder training
- Moisture alarms
- Medications.
Both the parents and child should take an active part in deciding which recommended treatment makes the most sense for their particular situation.
Bladder Training
Bladder training can help a person hold urine longer. Bladder training for bedwetting consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate, and prevent urination when away from a toilet.
Techniques that may help bedwetting include:
- Determining bladder capacity
- Drinking less fluid before sleeping
- Developing routines for waking up.
Write down what times your child urinates during the day. Then figure out the times between trips to the bathroom. After a day or two, have your child try to wait an extra 15 minutes before using the bathroom. If the child usually goes to the bathroom at 3:30 p.m., have him wait until 3:45. Slowly make the times longer and longer. This method is designed for children with small bladders. It helps stretch the bladder to hold more urine. Be patient. Bladder training can take several weeks, or even months.
Moisture Alarms
At night, moisture alarms can awaken a person when he or she begins to urinate. These devices include a water-sensitive pad that is worn in pajamas or placed on the bed. An alarm sounds when moisture is first detected. For the alarm to be effective, the child must awaken as soon as the alarm goes off, go to the bathroom, and change the bedding. This may require having another person sleep in the same room to awaken the bedwetter.
Medications
Bedwetting may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressin, or DDAVP, which recently became available in pill form. Patients can also spray a mist (containing desmopressin) into their nostrils. Desmopressin is approved for use by children.
Another medication, called
imipramine (
Tofranil®), is also used to treat bedwetting. It acts on both the brain and the urinary bladder. Researchers estimate that these medications may help as many as 70 percent of people achieve short-term success. Many people, however, relapse once the medication is stopped.
If a young person experiences bedwetting resulting from an
overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms, and belongs to a class of medications called anticholinergics.
