Bedwetting (enuresis)

What is bedwetting?

Bedwetting, also called nocturnal enuresis, is a problem with bladder control that leads to urinating at night while a child sleeps.

This is quite normal in infants and younger children, but it may be more of a medical problem if it continues after the child is 5-6 years old, or if it happens in a child who was dry for a period of time, and then starts bedwetting again.

Bedwetting happens for different reasons. Some children make so much urine at night that their bladder cannot hold it all. This happens when a child drinks lots of fluid in the evening.

It also can be due to not making enough antidiuretic hormone (ADH), which regulates the production of urine in the kidneys at night. In children with low levels of ADH, too much urine is made.

In other children, the bladder may be smaller than usual and not able to hold a normal amount of urine. Many children with bedwetting also are very deep sleepers, which prevents them from feeling the urge to urinate and waking up. Less commonly, bedwetting can be caused by an infection in the urine or by a disease such as diabetes. Anatomical defects (how it is shaped and put together) in the urinary system or a problem in the central nervous system (brain and spinal cord) can cause bedwetting.

Sometimes emotional stress, such as the stress of a divorce, changing schools or new baby in the house, can lead to bedwetting in children who have been previously dry, even at night.

As with other developmental milestones, children have full bladder control at different times. It is estimated that approximately 10-20% of all 5-6 year old children still wet the bed. The condition is more common in boys than in girls, and tends to run in families. If the child has never been dry all night, the condition is called primary enuresis. This is the most common form of bedwetting.

In secondary enuresis, the child has been dry at least six months before bedwetting starts again. Secondary enuresis may be a sign of a medical problem or by emotional stress.

Treatment / What you should do

Do not expect that your child will be dry at night, consistently, before he is 5 or 6 years old. Most children who wet the bed at night will be dry eventually, as they grow older, even without treatment.

It is important not to punish your child for wetting the bed; this is a developmental issue, and your child does not have control of his or her bladder at night.

If nightly wetting is still present when the child is 6-7 years old, it may be helpful to seek treatment. Bedwetting can be embarrassing when the child begins wanting to spend the night at friends' houses. Speak with your doctor about the problem. The doctor will examine a urine sample to rule out an infection of the urinary tract or other problem, and then will discuss treatment options.

Treatment of bedwetting that is caused by a medical problem depends on the specific cause. If your child does not have a specific medical problem, but continues to wet the bed there are several treatment options.

Motivational or behavioural therapy can help train the child to stay dry at night. Start by limiting fluids in the evening and making sure your child goes to the bathroom right before bed. Let your child help change the bed after wetting. For some children, a bedwetting alarm may be helpful.

This device, fastened to the pajamas or bed sheet, goes off when the child starts to urinate. It can help train the child to awaken before a full urine outflow occurs. The alarm does not work for all children. If your child does not awaken by himself during the first 2-3 weeks using the alarm, you should try to help him/her. Get up when the alarm rings, wake your child and get him/her to turn off the alarm. Then take the child to the toilet, so that he/she can empty the rest of his bladder. The alarm should be combined with the child keeping a diary or sticker chart of "dry" and "wet" nights.

Another treatment option is to give your child medicine to increase the amount of antidiuretic hormone, ADH. This medicine, called desmopressin, is a man-made drug that acts like ADH. The child takes an evening dosage of this medicine, either as pills or as a nasal spray, and it works overnight to decrease urine production. This medication works for many children, with the effect lasting up to 3 months even after the treatment is stopped. If the bedwetting returns, another course of this medication can be given. If the medication has no effect, you can wait 3-6 months and then try it again.

Even though it means doing a lot of laundry, you should avoid using diapers or pull-ups on children over 6-7 years old. Diapers may be useful however as a temporary solution if the child is to stay overnight with friends, or goes on vacation where washing opportunities are limited.

It is important that you show understanding of your child, and avoid scolding about the bedwetting. The child cannot do anything about the urine outflow himself, and scolding will only make things worse. The child needs support and assurance that this is a common problem for many children. If you were a bed wetter as a child, you should tell this to your child to reduce his or her feelings of shame. In many children, particularly those with a family history of bedwetting, it simply takes time for them to learn to control their urine outflow at night.