Bedwetting, also known as nocturnal enuresis, or night-time incontinence, is common in young children whose bladders are still developing. It affects 15 percent of children at the age of 5 years, and it is not considered unusual at the age of 6 years.
Pediatricians say it is one of the most common reasons for parents to seek medical help.
Girls will normally be dry at night, on average, by the age of 6 years, and boys by the age of 7 years. By 10 years, 95 percent of children are dry at night.
Types of enuresis
Bedwetting is common up to the age of 5 or 6 years.
There are two main types of enuresis:
- Nocturnal enuresis, or night-time bedwetting. Boys account for 75 percent of cases.
- Diurnal enuresis, or lack of urination control during the daytime. This affects girls more than boys.
Night-time bedwetting can be either:
- Primary nocturnal enuresis (PNE), when the child has not yet been dry for a long period.
- Secondary nocturnal enuresis (SNE), when nocturnal bedwetting returns after a long dry period, usually of 6 months or more.
Up to the age 6 years, or perhaps 7 years for a boy, occasional bedwetting is normal, as long as the intervals between wet episodes are getting longer.
If the child of 6 or 7 years begins to wet the bed again after a long period without doing so, it may be worth seeking the advice of a primary care physician.
How does the body control bedwetting?
The body has two ways of preventing bedwetting.
While sleeping, the body produces an anti-diuretic hormone called arginine vasopressin (AVP). AVP reduces urine production. Around sunset each day, the human body starts releasing AVP, and kidney urine output decreases. The bladder is less likely to become full during the night.
Most children develop this hormone cycle between the ages of 2 and 6 years, but some may take longer. The longer it takes, the longer the bedwetting will continue.
If the bladder becomes full while sleeping, people normally wake up to use the bathroom. Most children develop this ability around the same time as when the AVP hormone cycle starts.
If the child is a very deep sleeper, if the nerves around the bladder are not yet developed enough, or if there is a combination of the two, they may take longer to wake up when the bladder is full.
As a child develops these two processes, they should become dry at night.
Why do children wet the bed?
The main reason is that the bladder is not yet fully developed. Some children's bladders develop more slowly than others. If the bladder is too small, it cannot hold so much urine.
Bedwetting can be worrisome for parents and children, but it normally resolves itself in time.
Other reasons include constipation and drinking too much liquid too close to bedtime, especially fizzy and other caffeinated drinks, as these increase urine output.
The Cleveland Clinic note that drinks that contain citrus and artificial additives such as dyes and sweeteners can irritate the bladder and add to the problem.
If a parent wet the bed as a child, the child is more likely to do so. A child whose parents did not wet the bed has a 15 percent chance of doing so. If one parent did, the child has a 40 percent chance of having the same problem, and if both parents did, there is a 70 percent chance that the child will too.
Sometimes, bedwetting is related to an emotional problem and stress. This may come from bullying, a death in the family, marital problems, or domestic violence.
Embarrassment and anxiety about other people's reaction to their bedwetting can make children more likely to wet the bed. If they feel embarrassed and worried, this can lead to leading to more bedwetting.
Parents should know that bedwetting is a common part of normal development. The child should be comforted and encouraged, and not made to feel guilty or embarrassed.
In most cases, say medical experts, the bedwetting is not the problem. The problem is how the child or family member reacts to it.
How is enuresis diagnosed?
Parents should only seek medical help if there is strong evidence of a health problem, or if the child is extremely distressed.
The primary care physician is usually the first person the child will see. They will ask questions about the frequency of bedwetting, the child's fluid intake before bedtime, how the child is coping emotionally and mentally, and whether there may be anything, such as bullying, that may be worrying the child.
The doctor may ask if the parents had a history of bedwetting as a child, and whether or not the child has had a urinary tract infection in the past.
A physical examination and imaging scans might be needed to see if there is any physical abnormality.
A urine test will rule out any possible underlying medical condition that could be linked to bedwetting, such as diabetes.
What is the treatment for enuresis?
If the doctor has ruled out a physical abnormality or underlying disease, they will probably advise the parents to wait for the problem to resolve itself without treatment, while offering the child comfort and support.
Treatment is not normally recommended below the age of 5 to 7 years. From the age of 7 years, if the problem is having a significant impact on the child and the family, there are a number of options.
An enuresis alarm is a tiny sensor that is attached to the child's underwear. As soon as it senses wetness, it makes a noise or vibrates, and the child wakes up. In time, the child will normally wake up automatically when the bladder is full. Some sensors vibrate as well.
Drug therapy, such as desmopressin, may be prescribed. This may be useful if the child is going away for a few days, perhaps for a sleepover, a school trip, or camp. Desmopressin makes the kidneys produce less urine during the night. The child and parents must be sure to follow the doctor's instructions carefully.
Medication is not considered the best option because it does not solve the problem in the long term.
Absorbent underwear can reduce embarrassment and give the child some control over their bedwetting.
Preventing and dealing with bedwetting
To reduce the chance of bedwetting, the child should:
- Drink plenty of fluid during the day, especially water, but reduce intake 2 hours before bedtime
- Avoid fizzy and other caffeinated drinks
- Use the bathroom before bedtime, and again before falling asleep if they are reading in bed or watching TV
- Eat plenty of fresh fruit and vegetables to avoid constipation.
To alleviate the problem, parents can:
- Make night-time bathroom visits at stress-free and easy, for example, by having a dim light in the hall
- Place a potty in the bedroom, if the bathroom is far away
- Protect the mattress with a waterproof sheet
- Give an older child the option of making their own bed if they wake up wet in the night, and provide clean sheets and a laundry basket
- Ensure the child has a shower in the morning, to remove odors and prevent teasing at school.
It is important to stay neutral. If a child wakes you up at night, comfort them, remake the bed and put them to sleep normally without making a big fuss. Parents should let the child know that everything is and will be all right, and that it is not a big deal.