Bedwetting is a very common problem affecting twice as many boys as girls.   It is much more common in families where one or both parents were bedwetters after five years of age.  By age three, most children gain daytime bladder control, but wetting the bed at night may be normal up until age 6 years.   For the most part children who remain bedwetters after that time are healthy. 

What causes bedwetting?

The most common cause of bedwetting is the child’s bladder is not developed enough and cannot store as much urine as a normal bladder.  Because of the small bladder capacity, the child runs to the bathroom often.  The child may need to have to get up to go at night or may wet the bed, sometimes more than once.  

If the child is under six years of age, simply waiting another year may begin to clear up the problem.

If your child is older than six years or if the child was previously dry at night and has begun wetting the bed again, it is a good idea to have your child seen by your doctor.  A good history, physical examination, and a simple urine test will rule out underlying causes that need further investigation.  If further tests are needed, your pediatrician can decide which tests need to be done.   Your doctor can then help you with further advice. 

Diabetes and urinary infections must be ruled out. 

A small number of children may have an underlying kidney disease, an abnormality of the bladder or the valve controlling emptying the bladder, or a problem with the hormone that regulates concentration of urine in the kidney.  In these cases the underlying medical problem must be addressed.

Sometimes, emotional upheavals in a family as death, divorce, or a move may start or re-start bedwetting.  Counseling may help if this is the case.

Never punish your child for bedwetting. S/he cannot help it.   Wearing diapers or pull-ups may hurt an older child’s self esteem.  It is better to use rubber sheets.  Have your child bring the sheets to the washer, but don’t make him or her wash them unless s/he wants to help.  Enlisting their aid in cleaning up the soiled sheets is often beneficial.

Limiting fluids after dinner and getting the child up to use the bathroom when you go to bed may prevent the wet bed.  S/he may still wet the bed later in the night when the bladder fills up again.

The most common and effective treatments are enuresis alarms, retention training control, stream interruptions, and a system of rewards.  The alarm wakes the child as soon as s/he begins to wet the bed.  It is made up of a moisture-sensing patch attached to the child’s underwear connected to a battery-powered alarm placed near the child’s ear.   Initially the child wakes up after s/he has urinated or may need to be awakened by the parent.  After a time, the child may begin to sleep through the night or get up to urinate.  It takes four to six months to be effective, so be patient.   An alarm system may be covered by insurance.  It is best to check with your insurance carrier ahead of time.  Alarms are not recommended in children under six years of age.  Avoid scams that say they can come and train your child for a lot of money!

Retention control helps the child to hold more urine in his or her bladder.  During the day, give your child plenty of fluid to drink.  When your child has to go, have him or her hold a few minutes longer than usual and then have the child urinate into a measuring cup.  Have your child then record that amount on a calendar.  Give a simple reward as s/he beats previous records.   Distract the child with reading, playing, or drawing as you help your child wait to go to the bathroom.  Once the child can retain 14 to 16 ounces of urine, they often become dry at night.

Stream interruption is easy and strengthens the muscle that controls urine flow. Once a day (or more) have the child start urinating and then stop in midstream and the start again.  It is usually fun and the child will often do it with a little encouragement. 

A reward system is important to help the child.  It is wise to remember bedwetting is not usually a voluntary act.   Also remember that the child will fail many times before s/he is successful.  Therefore, keep a sense of balance. Avoid giving the impression that it is the most important thing your child’s life.  Encourage other things as well.  Keep a “matter of fact” about it.

Effective reward suggestions include:  star charts, stickers, points that add up to special prizes, or special treats or prizes after a period of dry nights.  Another suggestion is to have the child name a prize.  Make a rough drawing of the prize using the dot-to-dot format.  When the child connects all the dots, award the prize.  You get the idea make this fun.

What about medication?  Medication is another option.   It works in about 70 to 80 % of the time.  You and your doctor may choose medication to bring about quicker success.  Medication may be used alone or in combination with the above techniques. 

Imipramine, an antidepressant, works by altering sleep problems.  It can cause drowsiness, irritability, nausea and dry mouth.  Its dose must be stepped up gradually.  At doses of 50 mg or more a day, the heart must be monitored for possible rhythm problems, but children rarely need dosages that high for bedwetting.  It is relatively inexpensive. 

DDAVP or desmopressin works by increasing the concentration of the urine by the kidney, which puts less urine in the bladder.  It has relatively few side effects.  It comes as a nasal spray and as a pill.  It is expensive, but may be covered by some prescription plans. 

Regardless of which option you and your provider choose, about 20% of bedwetters outgrow the problem every year.  Only 2% of 18-year-old army recruits are still wetting the bed.  The opportunity for success over time is excellent.