Condition Overview

What is bedwetting?

Bedwetting is urination during sleep. Children learn bladder control at different ages. Children younger than 4 often wet their beds or clothes, because they can't yet control their bladder. But by age 5 or 6 most children can stay dry through the night.

Bedwetting is defined as a child age 5 or older wetting the bed at least 1 or 2 times a week over at least 3 months. In some cases, the child has been wetting the bed all along. But bedwetting can also start after a child has been dry at night for a long time.

Wetting the bed can be upsetting, especially for an older child. Your child may feel bad and be embarrassed. You can help by being loving and supportive. Try not to get upset or punish your child for wetting the bed.

What causes bedwetting?

Children don't wet the bed on purpose. Most likely, a child wets the bed for one or more reasons, such as:

• Delayed growth. Children whose nervous system is still forming may not be able to know when their bladder is full.
• A small bladder. Some children may have a bladder that gets full quickly.
• Too little antidiuretic hormone. The body makes this hormone, which rises at night to tell the kidneys to release less water. Some children may not have enough of this hormone.
• Deep sleeping. Many children who wet the bed sleep so deeply that they don't wake up to use the washroom. They probably will wet the bed less often as they get older and their sleep pattern changes.
• Emotional or social factors. Children may be more likely to wet the bed if they have some stress. For example, a child may have a new brother or sister.

Children who wet the bed after having had dry nights for 6 or more months may have a medical problem, such as a bladder infection. Or stress may be causing them to wet the bed.

How is it treated?

Treatment usually is not needed for bedwetting in children ages 7 and younger. Most children who are this age will learn to control their bladders over time without treatment.

But if your child older than 7 wets the bed at least 2 times a week for at least 3 months, treatment may help your child wet the bed less often or help him or her wake up to use the toilet more often. You and your child may also decide to try treatment if bedwetting seems to be affecting how your child is doing with schoolwork or getting along with his or her peers. Treatment may involve a praise and reward system (motivational therapy), a moisture alarm, or medicine. One or more of these methods may be used.

If bedwetting is caused by a treatable medical problem, such as a bladder infection, the doctor will treat that problem.

What can you do to help your child?

Help your child understand that controlling his or her bladder will get easier as your child gets older.

Here are some other tips that may help your child:

• Give your child most of his or her fluids in the morning and afternoon.
• Have your child avoid caffeine, such as from chocolate or colas.
• Have your child use the toilet before he or she goes to bed.
• Let your child help solve the problem, if your child is older than 4. He or she can help decide which treatments to try.
• Encourage your child by praising successes.

Cause

Almost all children who wet the bed do not do so intentionally. Most likely, several things are involved when a child older than age 5 continues to wet the bed. Possible causes of primary nocturnal enuresis include:

• Delayed development. Children with a less mature nervous system may not be as able to sense when the bladder is full.
• Small bladder capacity. Having a smaller-than-normal bladder may make some children more prone to wet the bed.
• Too little antidiuretic hormone (ADH). Levels of antidiuretic hormone (ADH), a brain chemical that signals the kidneys to release less water, normally rise at night. Some children who wet their beds may not produce more ADH at night.
• Sound sleeping. Many parents note that their child who wets the bed is a deep sleeper. These children usually wet the bed less often as their sleep patterns mature.
• Psychological and social factors. Bedwetting does not appear to be a direct result of emotional problems. In fact, bedwetting may be the cause of some emotional problems for children. But children living in stressful home situations or in institutions may be more likely to wet the bed.

Some of these things may be inherited. A child is at increased risk for wetting the bed if one or both parents has a history of bedwetting as a child.

Most cases of primary nocturnal enuresis are not caused by any medical condition. But secondary nocturnal enuresis, which is bedwetting that occurs after a period of staying dry, is more likely to be related to a medical condition. Examples of physical causes include a kidney or bladder infection (urinary tract infection) or birth defects that affect the urinary tract. Emotional stress, such as may result from the birth of a brother or sister, can also be something that triggers bedwetting.

Symptoms

Bedwetting is not a disease, so it has no symptoms. For a child who has never had nighttime bladder control for more than 3 months, overcoming this problem is usually a matter of normal development.

If a child has other symptoms, such as crying or complaining of pain when urinating, sudden strong urges to urinate, or increased thirst, bedwetting may be a symptom of some other medical condition. Call the doctor if your child has any of these symptoms.

What Happens

Bedwetting is common in young children. Children grow and develop at different rates, and bladder control is achieved at an individual pace. Usually, daytime bladder control occurs before nighttime control.

Children may wet the bed several times during the night, and they may not wake up after wetting.

Primary nocturnal enuresis—bedwetting that continues past the age that most children have nighttime bladder control—will usually stop over time without treatment. If a medical condition is causing the bedwetting, treating the condition may stop the wetting.

Treatment often does not completely stop bedwetting, but it may reduce how often it occurs. Although bedwetting may return when treatment is stopped, repeating or combining treatments may have longer-lasting results.

Sometimes bedwetting is related to emotional stress. Bedwetting usually stops when the stress is relieved or managed.

The emotional responses to bedwetting can impact the relationship with your child. If you or your child is having difficulty with handling bedwetting, you may wish to find out about treatment options.

Some children who wet the bed also experience accidental daytime wetting. When wetting occurs during both the day and night, usually the things related to the daytime wetting are explored first.

What Increases Your Risk

Children who develop at a slower rate than other children during the first 3 years of life have an increased likelihood of wetting the bed. Boys tend to develop more slowly, so they are more likely than girls to wet the bed.

A child may inherit the tendency to wet the bed.

When To Call

Call your doctor if:

• Your child has signs of a bladder or kidney infection such as:
  • Cloudy or pink urine or bloodstains on underclothes.
  • Urinating more often than usual.
  • Crying or complaining when urinating.
  • Back pain.
  • Belly pain.
  • Fever.
• Your child age 4 or older is wetting the bed and is leaking stool. The child may have stool blocking the intestines, caused by having constipation over a period of time.
• Your child wets the bed more often while you are using home treatment for bedwetting.
• Your child age 5 or older has never had bladder control for more than 3 months in a row after trying home treatment, and it is causing problems at school or in the child's relationships with family and friends.
• Your child who has had bladder control for at least 3 months has begun to wet the bed, and this has happened more than a few times.

Watchful waiting

Watchful waiting is okay if bedwetting is not affecting how your child is doing with schoolwork or getting along with peers or family. Most children develop complete bladder control even without treatment. Home treatment may be all that is needed to help the child learn bladder control.

Watchful waiting may not be a good choice if bedwetting starts after a child has had bladder control for a period of time. Look for possible stresses that might be causing the bedwetting. Bedwetting may stop when your child's stress is relieved or managed. If it doesn't, your child should see a doctor.

Examinations and Tests

Any child beyond age 6 or 7 who continues to wet the bed may need to be evaluated by a doctor. The evaluation should include a urinalysis.

A medical history and a physical examination are also part of a medical evaluation of bedwetting. If you are having your child evaluated for bedwetting, keep a diary for a week or two before your visit. Write down when wettings occur and how much urine is released.

In some cases, further testing may be needed. Tests may include:

• A urine culture to find out if your child has a bladder or kidney infection.
• Psychological testing, if emotional stress is suspected.

If a child has uncontrollable wetting both at night and in the day, other tests may need to be done.

Treatment Overview

Most children gain bladder control over time without any treatment. Bedwetting that continues past the age that most children have nighttime bladder control—typically at 5 or 6 years of age—also will usually stop over time without treatment. If not, home treatment may be all that is needed to help a child stop wetting the bed. For more information, see the Home Treatment section of this topic.

If home treatment is unsuccessful, if the child and parents need assistance, or if the bedwetting may be caused by a medical condition, medical treatment may be helpful. Medical treatment may help your child wet the bed less often or help him or her wake up to use the toilet more often.

Treatment for bedwetting is based on the:

• Child's age. Some treatments work better than others for children of a specific age group.
• Child's and parents' attitudes about the bedwetting. If gaining bladder control is seen as a normal process, it is usually easier for the child to stop bedwetting.
• Home situation. If the child shares a bedroom with other children, certain techniques to arouse the child, such as some moisture alarms, may not be practical.

Treatment for bedwetting may include:

• Motivational therapy. This method involves parents encouraging and reinforcing a child's sense of control over bedwetting.
• Moisture alarms, which detect wetness in the child's underpants during sleep and sound an alarm to wake the child.
• Desmopressin. This medicine decreases the amount of urine released by the kidneys.

Treatment may be helpful if bedwetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with his or her peers.

The best solution may be a combination of treatments. Below are some suggestions for treatment options according to the age of your child.

• Ages 5 to 8: Help your child understand that wetting the bed is a normal part of growing up. Encouragement and praise may be all that is needed to help your child wake up before wetting. Praise and reward your child for the steps he or she takes to have dry nights. And have your child take an active role in cleaning up after wetting.
• Ages 8 to 11: If your child still wets the bed, a moisture alarm may be a successful treatment option. Also, a medicine such as desmopressin can be helpful for occasional overnight events such as camp or sleepovers.
• Ages 12 and older: There can be significant emotional effects if bedwetting persists at this age, so treatment can be more aggressive. If consistent use of moisture alarms does not work, the doctor may suggest medicine and/or counselling.

What about treatment for daytime wetting?

Accidental daytime wetting may be a normal part of a child's development, or it may point to a medical condition. Talk to your child's doctor if your child has daytime wetting.

What to think about

Treatment for bedwetting is usually not a cure. The goal is to reduce the number of times the child wets the bed and to manage the wetting until it goes away on its own.

Some children who finish a treatment and have dry nights for a while will start to wet the bed again. Repeating treatment, especially with a moisture alarm, usually helps bring back dry nights.

Counselling (psychotherapy) may be helpful for the child who has secondary enuresis or for bedwetting that is caused by emotional stress. Psychotherapy involves talking with a trained counsellor. The counsellor helps the child identify and deal with the emotional stress that may be causing him or her to have accidental wettings. The goal is to reduce or help manage the stress or to prevent stress from occurring.

Prevention

Learning to use the toilet is a natural process that occurs when children are old enough to control their bladder muscles and to know when they are about to wet. It is normal for young children to have accidental bed-wettings while they are learning to control their bladders.

If you are teaching your child to use the toilet, be patient. Some children are slower than others in gaining complete bladder control. Stay positive and encouraging, and learn about the normal development of bladder control. For more information, see the topic Toilet Training.

You can help prevent or reduce bedwetting by limiting your child's fluid intake in the evenings. Do not give any drinks containing caffeine, such as cola or tea. Also, remind your child at bedtime that he or she should get up at night to use the washroom if needed.

Self-Care

Most children gain bladder control over time without any treatment. A child should first be allowed to overcome bedwetting on his or her own. But home treatment may help a child to wet the bed less frequently.

You can help manage your child's bedwetting:

• Monitor your child's consumption of liquids. As a rule of thumb, children should be encouraged to consume 40% of their total daily liquids in the morning, 40% in the afternoon, and 20% in the evening. Talk with the doctor about how much fluid your child needs.
• Have your child avoid caffeine. Caffeine is a diuretic, which means that it promotes the excretion of urine. Foods such as chocolate and beverages such as colas and tea may contain caffeine.
• Have your child use the toilet before going to bed.
• Remind your child to get up during the night to go to the washroom. It may help to keep a night-light near or potty chair beside the bed.
• Let your child help solve the problem, if he or she is older than 4.
• Praise and reward your child for taking steps to have more dry nights. Involve your child in planning the reward system. You may want to use a calendar and put stars or stickers on the days that your child does not wet the bed. You know your child. If you think a reward system will help your child, then try it. If you think it may make your child feel worse, then do not use a reward system.
• Encourage your child to take responsibility for changing clothes and linens after a bedwetting accident. For example, use washable sleeping bags as bedding so your child can easily replace one that is wet with one that is dry.
• Add 125 mL (0.5 cup) of vinegar to the wash water to get rid of the urine odour in clothing and bed linens.

If your child wets the bed, don't blame yourself or the other parent. Don't punish, blame, or embarrass your child. Your child is neither consciously nor unconsciously choosing to wet the bed. Give your child understanding, encouragement, love, and positive support.

• Be patient about changing the bed linens. Don't act offended by the smell of urine.
• Do not wake the child up at different times during the night to go to the washroom unless it is part of a systematic treatment that the child has agreed to.
• Do not make the child feel bad. Shaming or punishing the child may make the problem worse.
• If you think your child may be feeling emotional stress, talk with a health professional about whether counselling may be helpful.

Medicines

Medicines that either increase the amount of urine that the bladder can hold (bladder capacity) or decrease the amount of urine released by the kidneys may be used to treat bedwetting. These prescription medicines may be used to control bedwetting for a little while. They don't completely stop it.

• Medicines work well to control accidental wetting for short periods of time, such as when children are on overnight trips or at camp.
• Your doctor may suggest them for bedwetting that is related to a stressful event, such as divorce or the birth of a sibling.
• Sometimes medicines are used along with other treatments or for children who have not been able to control bedwetting with other treatments. Medicines can help to encourage and motivate a child who is having trouble with other treatments by letting the child feel what it is like to have dry nights.

Medicine choices

• Desmopressin for Bedwetting (DDAVP)

In a few cases, when a small bladder capacity or overactive bladder is thought to be the cause of bedwetting, oxybutynin (such as Ditropan) may be used to treat bedwetting, especially when the child also has daytime accidental wettings.

Other Treatment

You may hear of other ways to help children who wet the bed. But not all of these treatments have good evidence that they help. Talk to your doctor before you spend time and money on these other treatments. Ask about the risks and benefits. Examples include:

• Acupuncture.
• Bladder-stretching exercises that teach the child to hold urine for longer periods of time.
• Dry-bed training, which consists of following a strict schedule for waking the child up at night until he or she learns to wake up alone when needed.
• Hypnosis.
• Waking your child and taking him or her to the toilet a few times each night, or having your older child wake himself or herself a few times each night to use the toilet.

It's not a good idea to have your child wear diapers or pull-ups at night on a regular basis. Using diapers can get in the way of proven treatments (such as motivational therapy and moisture alarms) that require a child to get up at night.