Bed-wetting is involuntary urination during sleep in children. Typically children become able to sleep through the night without wetting around ages 3 to 5 years. Talk to your doctor if your child has bed-wetting after age 5 years. There are two types bed-wetting (also called enuresis):
Bed-wetting is common and not related to a medical condition. Most will stop by the time the child reaches puberty. However, bed-wetting remains a problem for up to 1% of adults.
- Primary nocturnal enuresis (PNE)—no periods of nighttime dryness
- Secondary nocturnal enuresis (SNE)—periods of nighttime dryness longer than 6 months followed by bed-wetting
CausesSome bed-wetting may be caused by infections or abnormalities of the urinary system. Most bed-wetting has no explanation.
Some factors that may contribute to bed-wetting include:
- Bladder control that develops more slowly than normal
- Greater than average urine production at night
- A sleep disorder, sometimes related to enlarged tonsils or adenoids
- A tendency for deep sleep
- Kidney or bladder infections
- Kidney disease
- Diabetes mellitus
- Diabetes insipidus (a very rare disorder in which sugar is normal but excess water is excreted by the kidney)
- Congenital bladder, kidney, or neurological abnormality
Risk FactorsFactors that increase the chance of bed-wetting include:
- Family members with a history of bed-wetting
- Significant psychosocial stressors, such as:
- Moving to a new home
- Loss of a loved one
- A new baby in the home
- Initial toilet training that was too stressful
- Physical or sexual abuse
- Chronic constipation
When Should I Call My Doctor?
Most children will have bladder control at night by about 5 years of age. Talk to your doctor if your child is about 5 years old and is still wetting the bed. Your doctor can help determine if the bed-wetting is just a normal part of your child's development or is caused by a condition that may need treatment.
Also call your doctor if you child:
- Wets their pants in the daytime
- Has pain during urination
- Has to go to the bathroom often
- Has blood in the urine
- Has fever or chills
DiagnosisThe doctor will ask about symptoms and medical history. A physical exam will be done. Your doctor will ask about:
- Family history of bed-wetting
- Daytime urinary patterns
- Problems urinating, such as pain or weak stream
- Usual intake of fluids
- Type of fluids consumed
- Presence of blood in the urine
- Strained family dynamics around the issue of bed-wetting
- Child's emotional response to the behavior
- Recent psychological trauma
Your doctor may order tests to look for infections or structural problems:
- Urine sample—to check for infections and other problems with the urinary tract
- X-rays or ultrasound —if a physical abnormalities is suspected
TreatmentMost treatment aims to gradually reduce the number of bed-wettings until the child grows out of it. Treatment is rarely appropriate before age six. Bed-wetting does not interfere with social development until after age 6 years.
If your child's bed-wetting is caused by an infection or physical abnormality, your doctor will create a treatment plan for that issue.
Motivation and Family SupportBed-wetting is rarely an intentional act. Children are usually upset and ashamed when it happens. Do not punish the child. It is very important that parents offer encouragement. The bed-wetting will stop with time. Do not let siblings tease the child who wets the bed.
Keep careful records of the child's progress. Offer consistent support. A very simple motivational method is the use of positive feedback, such as a star chart.
Avoid giving the child anything to drink after 6:00-7:00 in the evening. Have your child void before going to bed. Sugar and caffeine should also be avoided after late afternoon.
Behavioral ConditioningThe doctor may recommend a conditioning device. One example is a pad with buzzer that sounds when wet. The child wears the pad in his underwear. The alarm will wake the child up so he/she can use the toilet. Parents may need to help the child get to the bathroom and reset the alarm.
Some doctors suggest bladder-stretching exercises. While awake, the child gradually increases the amount of time between urinations. Do not try this method without talking to the doctor. Holding in urine can lead to urinary tract infections.
MedicationMedicine is rarely given. It may be used for short term situations like a sleepover or vacation. Medication that may be considered include:
- Desmopressin (DDAVP)—a hormone that decreases the amount of urine that is made
- Imipramine (Tofranil-PM, Tofranil)—an antidepressant that lightens the level of sleep and may also decreases how often your child urinates
- Oxybutynin (Ditropan XL, Ditropan, Oxytrol)