Overview
Bedwetting is common for children, affecting more boys than girls. The condition occurs in 30% of children at the age of 4, 10% at the age of 6, and drops to 1% by the age of 18. Although children develop bladder control at different rates, most boys can control their bladder during the day and night by the age of 6, and most girls by the age of 5. When a child who is old enough to have bladder control urinates accidentally while sleeping, it's called nocturnal enuresis.
Causes
There are two main types of nocturnal enuresis: primary and secondary. The primary type is a condition where a child still wets the bed after age 5 or 6. It's often hereditary. The secondary type occurs when a child who had stopped bedwetting for at least six months starts again, often due to emotional stress or a medical condition.
Possible causes of primary nocturnal enuresis include the following:
- delay in maturation of bladder control
- genetics - children with parents who also wet the bed beyond age five are at an increased risk for bedwetting
- sleeping soundly - this may make children less aware of cues for the need to urinate
Rare possible causes include the following:
- problems with antidiuretic hormone (ADH), a hormone that causes the body to retain water - Normally, ADH levels increase at night to decrease the amount of urine produced. However, children with enuresis do not have increased ADH levels at night, causing greater urine production, which can lead to wetting.
- minor nerve damage - this may decrease a child's ability to sense a full bladder
Although it is often said that emotional stress causes primary nocturnal enuresis, there is little scientific evidence to support this claim. However, bedwetting itself may lead to feelings of shame and lowered self-esteem.
Causes of secondary nocturnal enuresis include the following:
- emotional stress (e.g., birth of a sibling, significant loss, family discord)
- urinary tract infection
- diabetes mellitus
Symptoms
For sleeping children who are old enough to control their bladders, the symptoms of bedwetting are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them.
The most common complication of bedwetting is the impact on self-esteem and the emotional distress it causes children. Assuring children that the occurrences are accidental, and not blaming the condition on them, is key to managing the psychological effects. Many children who wet the bed may fear staying overnight at a friend's house in case they wet the bed there.
Treatment
Children under the age of five or six aren't treated for bedwetting because they generally outgrow the problem.
Here are some strategies for parents to help children who are wetting the bed:
- realize that bedwetting is fairly common up to age 5 to 6.
- keep a matter-of-fact attitude and convey that this is nothing out of the
ordinary.
- don't blame the child; offer support and encouragement instead.
- point out that bedwetting is common, that it can be corrected, and that there's nothing to feel guilty about.
- don't get angry when your child wets the bed, because this can cause the child to give up trying to stop bedwetting, or can lead to emotional problems.
- don't give lots of fluid or caffeine (like chocolate or cola beverages) to children before bedtime.
- encourage your child to urinate before going to bed.
- make sure your child has easy access to the toilet, and encourage them to get up and go to the toilet if they feel the urge to urinate during the night.
- keep a night light on in the bathroom so children can change their clothes or go to the washroom.
Actively treating bedwetting may be helpful if a child's relationships or school performance are being significantly affected. Treatment may involve bedwetting alarms or medications.
A bedwetting alarm is triggered when the child passes the first few drops of urine and wakes him or her up. Alarms become effective for most children after they have been used for 12 weeks. Alarms are most effective for children over 7 or 8 years of age. For alarm treatment to be successful, the child must be motivated and the parents must be willing to have their sleep interrupted. In some cases, the child may not be woken up by the alarm during the first few weeks, and parents must wake the child.
Medications are another option for bedwetting. Children five years old and older may take desmopressin*, a medication available as a nasal spray or tablets, that decreases the amount of urine the body makes. Desmopressin works well for bedwetting and doesn't have many side effects. For parents without drug plans, cost can be a factor. It does not permanently stop bedwetting, but it does help while it is being used. This medication is particularly useful to help children during sleepovers and overnight trips.
An antidepressant called imipramine used to be commonly used, but is now only used as a last resort. This medication can be used by children older than 6 years and it usually works quickly to treat bedwetting. The total treatment time is usually three or four months. After this time, the dose is slowly decreased until the medication is stopped. Unfortunately, many children experience side effects such as irritability and anxiety while taking the medication. Imipramine can also have dangerous side effects if the child accidentally takes too much. In addition, 75% of children using imipramine start bedwetting again once they stop taking the medication. If this happens, imipramine is recommended again for another three months.
If there are family problems (psychiatric or emotional) affecting either the child or another member of the family, these may also be root causes of bedwetting and need attention. Otherwise, the bedwetting can lead to life-long emotional and psychological distress.
In the rare cases where the bedwetting is due to a urinary tract infection, it is important to treat the infection and to investigate why it occurred.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
Other tips:
Since many children under the age of six still wet the bed, any one of the following signs should signal the need to consult a doctor:
- a child over the age of 5 or 6 who still wets the bed
- a child who is wetting during the day after the age of 4 or 5
- a child who starts bedwetting at night after having stopped for six months or more
- urinary symptoms such as urinating frequently or having pain with urination
Laboratory tests can be done to make sure the bedwetting isn't caused by a urinary tract infection or by other medical conditions such as diabetes.
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