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When young children are asleep, it can be difficult for them to control their urination. This results in nocturnal enuresis, or bedwetting. It is not unusual for this to happen until they are 6 years of age.
Also known as nighttime incontinence, bedwetting is common when a child is growing, and their bladder is still developing.
One 2014 study notes that bedwetting affects around 5–10 percent of all 7-year olds in the United States, and that it is more common in boys than girls. Between 5 and 7 million children have urinary incontinence during sleep.
Bedwetting can lead to embarrassment and distress. It is worth remembering that children develop at different rates, and this is often the reason why bedwetting continues.
The Urology Care Foundation suggest that people consider seeing a doctor if nighttime bedwetting continues after 7 years of age. A range of treatment options is available.
There are two main types of nighttime bedwetting, as we describe here:
Primary nocturnal enuresis: This is when the child has not yet been dry for an extended period. It is the most common type. The child may continue to wet the bed at night but be dry during the day.
Secondary nocturnal enuresis: This is when nighttime bedwetting returns after a long, dry period, usually of 6 months or more. This may be related to a stressful event, such as the loss of a loved one. Sometimes, it may stem from a medical condition or medication.
If the child at 7 years of age still wets the bed, it may be time for them to see a doctor, though up to 10 percent of children still have primary nocturnal enuresis at this age.
Any child who begins to wet the bed after a long, dry period should see their doctor.
Researchers have not identified a single reason for nighttime bedwetting, but three main mechanisms are likely to play a role:
- level of nighttime urine production
- overactivity of the bladder
- not waking up in response to bladder sensations
The following may affect the likelihood of having nocturnal enuresis.
If both parents experienced bedwetting as children, studies show that their offspring are also more likely to do so.
As a child grows, their bladder is also developing, and they gain more control over the muscles that control urination. This can happen at different rates.
Body clock and hormonal factors
When people sleep, the body produces an antidiuretic hormone called arginine vasopressin (AVP). AVP reduces urine production.
Around sunset each day, the body starts releasing AVP, and urine output by the kidneys decreases. As a result, the bladder is less likely to become full during the night.
Most children develop this hormone cycle between 2 and 6 years of age, but some may take longer. The longer it takes, the longer the bedwetting will continue.
If the bladder becomes full while a person sleeps, they typically wake up to use the bathroom. Most children develop this ability around the same time as when the AVP hormone cycle starts. It remains unclear why some children wake, but others do not.
Some parents have described their child as a “deep” sleeper, suggesting that they take longer to wake up when their bladder is full. Some children, however, have both nocturnal enuresis and sleep disruption.
Some children sleepwalk or have obstructive sleep apnea (OSA). These issues can cause the body to make more of a substance called atrial natriuretic peptide (ANP). ANP can cause the kidneys to produce extra urine at night.
When a person is constipated, it can put pressure on the bladder, sometimes resulting in urine leakage.
Drinking too much liquid too close to bedtime may increase the risk of bedwetting, especially if a person drinks fizzy and other caffeinated drinks, as these increase urine output.
Sometimes, a child may start wetting the bed again after an emotionally distressing event. However, for most children with enuresis, there are no such events or triggers.
The American Urology Foundation note that bedwetting is not usually due to behavioral issues, and it is unlikely to be an act of rebellion or laziness.
A combination of factors probably affects the likelihood of nighttime bedwetting occurring or persisting.
If a child has nocturnal enuresis at the age of 7 years or above, or if bedwetting returns after a long time of being dry, parents or caregivers can ask a doctor for advice.
The primary care physician is usually the first person the child will see. They will ask questions about:
- how often bedwetting happens
- whether the child has daytime wetting also
- are there any symptoms of constipation
- whether or not the child has already been dry for some time
- how much fluid the child drinks before bedtime
- whether anything may be causing anxiety, such as bullying
- whether the child has ever had a urinary tract infection
- whether either or both parents had nocturnal enuresis as a child
The doctor may carry out a physical examination and urine test to rule out any underlying medical condition, such as diabetes
If the child experiences persistent daytime eneuresis, frequent infections, or other symptoms, a doctor may recommend:
An imaging scan to check for possible physical causes
- a test to see how well the bladder stores and releases urine
- a cystoscopy, which involves putting a narrow tube with a lens into the bladder to check for any abnormalities, such as a tumor
Tests may not show any medical condition or physical feature that could be causing nocturnal enuresis.
In this case, a doctor may advise the parents or caregivers to wait for the problem to resolve without treatment while offering the child comfort and support.
A doctor will not usually prescribe treatment before the ages of 5 to 7 years.
From the age of 7 years, if enuresis is having a significant impact on the child and the family, there are a number of options.
An enuresis alarm
This is a tiny sensor that attaches to the child’s underwear. When it senses wetness, it makes a noise or vibrates, and the child wakes up.
In time, most children will wake up automatically when the bladder is full. It can take 2–3 weeks before it starts to be effective.
A doctor may prescribe drug therapy.
Desmopressin: This makes the kidneys produce less urine during the night. It may be useful if the child is going away for a few days, perhaps for a sleepover, a school trip, or camp.
Oxybutynin and tolterodine: These can prevent bladder spasms, which may help if the child has a small bladder.
A doctor will not usually prescribe oxybutynin as a first-line drug, but they may add it as a second option.
Tolterodine does not have approval for use in children, but a doctor may use it off-label.
Imipramine: This is an antidepressant medication that appears to improve bladder capacity and sleep patterns.
However, medication does not solve the problem in the long term. With any drug, it is important to follow the doctor’s instructions exactly.
This can reduce embarrassment and give the child some control over their bedwetting. However, using these undergarments also takes away the sensation of being wet during sleep.
For older children there is some concern that this may interfere with the natural process of learning to wake up to urinate.
For production: A wide range of products to help manage bedwetting are available for purchase online,
Embarrassment and anxiety can increase the risk of wetting the bed. It is important to remember that bedwetting is a part of natural development.
It is important to comfort and encourage a child who is concerned about bedwetting. People should never punish a child for wetting the bed.
Some people try herbs and supplement, but there is no evidence that these will help, and some may not be suitable for children. It is important always to ask a doctor before using a supplement or an alternative remedy.
Tips for children include:
- Drinking plenty of fluid during the day, especially water, but reducing intake 1–2 hours before bedtime.
- Avoiding sodas and other caffeinated drinks.
- Using the bathroom before bedtime, and again before falling asleep if they are reading in bed or watching TV.
- Eating plenty of fresh fruit and vegetables to avoid constipation.
Tips for parents include:
- Making nighttime bathroom visits easy, for example, by having a dim light in the hall.
- Placing a potty in the bedroom, if the bathroom is far away.
- Protecting the mattress with a waterproof sheet.
- Allowing an older child to change their clothes and make their own bed if they wake up wet in the night. Also, providing clean sheets, clothes, and a laundry basket by the bed.
- Ensuring the child has a shower in the morning, to remove odors and prevent teasing at school.
- Offering support with a minimum of fuss if a child wakes at night.
Strategies that do not appear to help include:
- Waking a child every few hours during the night to use the bathroom: This may work in the short term but is unlikely to have long-term benefits.
- Pelvic floor exercises: While these can be helpful for adults, they may encourage children to hold in their urine, increasing the risk of infections and other problems.
It is helpful for a parent or caregiver to let the child know that everything is and will be all right, and that nocturnal bedwetting is not a big problem and not their fault.
Bedwetting is a normal part of growing up, and most children become dry in time, although when this happens can vary.
If bedwetting continues after the age of 6 years, a child should see a doctor, who will be able to help.