Bedwetting: Answers to Parents’ 6 Top Questions

Common Questions on Bedwetting

From the WebMD Archives

Parents share secrets and strategies with each other about how to deal with fussy eaters, colicky infants, and tantrum throwers. But bedwetters?

The problem of bedwetting is still shrouded in embarrassment, despite the fact that it's very common. As a matter of fact, one in five 5-year-olds is a bedwetter, according to the American Academy of Pediatrics.

To help you understand why, here are answers to some of parents' most frequently asked questions about bedwetting.

Q: Why is my child bedwetting?

What you need to know before answering this is: Has your child consistently wet -- that is, never had dry nights -- or has your child been dry, and the bedwetting is a recent problem?

Those are two very different situations. Most of the time, the child was never dry, a problem known as primary bedwetting (or by the medical term, primary enuresis).

A much smaller number of children have what is called “secondary” bedwetting or enuresis. In this case, the child was dry for a long time, maybe a year, and then becomes a bedwetter. That is more unusual, and there is more likely to be a medical cause or a trigger, such as psychological stress or trauma. But that's true in less than 10% of cases.

Most of the time, a child has primary bedwetting, and after a thorough physical examination and examination of the urine, no medical reason is found. In that case, the cause is rarely figured out. But one in five kids at age 5 has this. How abnormal can that be?

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Q: What causes a child to be a bedwetter?

Bedwetting of the primary type does seem to run in families. So whatever the cause is, it is likely that children who are bedwetters have some sort of genetic reason. It's also possible one or both of their parents wet the bed.

The most popular theory is that bedwetters have a slight delay in maturation of their nervous system. When the bladder is full, the sleeping brain has to send a message down to the bladder not to pee. If your child's nervous system is a bit underdeveloped, the message might not get through.

Another theory is that children who are bedwetters are very deep sleepers. They are sleeping so soundly their brains don't tell their bladder to hold it.

Some experts also think that bedwetters may simply make more urine at night than other kids, and their bladder can't hold it all. Others hypothesize that their bladders have a smaller capacity to hold in the urine compared with kids who stay dry.

Q: What should be done about bedwetting?

The first step is to talk about it with your pediatrician, which many parents don't do because they (or their child) are embarrassed. But it's crucial to do so because the first step in assessing a bedwetter is to rule out any medical causes.

A urine test could reveal a urinary tract infection or excess sugar in the urine as a cause. A physical examination might demonstrate constipation, for instance, which could push on the bladder and cause the bladder to release urine at inappropriate times. A sleep history may reveal that a child has a sleep disorder called sleep apnea, in which breathing stops for a brief time. Urine can escape during those episodes.

Sometimes, secondary bedwetting can occur if a child is psychologically stressed or if he has lived through a disaster recently, such as a hurricane or fire. Those children may need some counseling or other help.

Most of the time, however, your child will naturally outgrow bedwetting as he gets older. To help your child outgrow bedwetting, you can try a number of behavioral strategies outlined below.

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Q: At what age should we do something about bedwetting?

If you and your entire family is OK with it, you don't necessarily have to do anything. Except wash the sheets, of course, and perhaps have your child wear disposable underwear. About 15% of bedwetters get better, or outgrow it, every year without any treatment. By age 18, only 1% to 2% still wet the bed.

But if you, or more importantly, your child, is so upset by this that it is disrupting your family, then talk about treatments with your pediatrician.

The best time to do this is when your child says he wants to deal with it. When the child gets sick of it, says he feels like a baby, or is embarrassed because he can't go to friends' houses for sleepovers, this is a good time to talk to your doctor about remedies.

Q: What bedwetting product or treatment works best?

There aren't a lot of great studies comparing treatments. But it's pretty clear that what works best are the urinary alarms. In a published review, researchers compared bed alarms with behavioral interventions and medications. They concluded that bed alarms are the most effective.

Many models of alarms are available, but all include a moisture sensor that you put in your child’s underpants that sounds an alarm when it detects urine. Once the alarms train the sleeping brain to inhibit the bladder contractions -- and prevent the urine from being released -- most kids stay dry. Better still, they remain dry even after the alarm is discontinued.

The downside of alarms? They take a while to work -- usually months. They require participation by the parents, who may have to get up with their child and take him to the bathroom when the alarm goes off. It requires a lot of commitment.

Another strategy is to wake your child two or three hours after he has gone to bed, and perhaps right before you go to bed, and have him pee. It has some effectiveness. You might also have your child wear disposable underwear until he or she outgrows bedwetting.

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Limiting fluids after dinner might also have some benefit. But if your kid is really thirsty, it's not worth it.

Some parents work with the child during the day to help him hold in the urine longer. They may set an egg timer when the child says he has to go and ask him to hold it for another few minutes, starting with five minutes and working up to 45 minutes or so. The theory is it will increase bladder capacity.

Medications are another option. One medication is desmopressin, which reduces the amount of urine produced at night. However, medications only work when they are taken. Once the medication is stopped, the bedwetting comes back.

Although medications have side effects, often they can be used on a short-term basis, such as when your child wants to go on a sleepover.

Q: What else can I do for my bedwetting child?

You can reassure your child that he will eventually grow out of it. No matter how frustrated you are, don't punish your child for bedwetting. Try to normalize the experience for the child; sit down and talk to them. Letting them know they are not the only child with this problem seems to make them feel better, or at least less humiliated.

WebMD Feature Reviewed by Hansa D. Bhargava, MD on March 16, 2012

Sources

SOURCES:

Steven Parker, MD, WebMD pediatric expert; director of behavioral and developmental pediatrics, Boston Medical Center; associate professor of pediatrics, Boston University School of Medicine; co-author, Dr. Spock's Babyand Child Care.

American Academy of Pediatrics: "Parenting Corner-Q&A: Bedwetting,” "Bed-Wetting and School-Age Children."

Glazener, C. Cochrane Database of Systematic Reviews 2000; published online April 24, 2000.

Glazener, C. Journal of Wound Ostomy Continence Nursing, July-August 2004; vol 31: pp 223-234.

National Kidney Foundation: "Bed-Wetting."

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