What causes bedwetting?

There is no one cause of bedwetting (and therefore no one cure). There is some evidence that there is a genetic predisposition toward bedwetting, meaning that if one or both parents wet the bed, then their child is more likely to have bedwetting. The most common factors that are involved in bedwetting are increased urine output at night (usually from increased fluid intake before bed but occasionally from a decreased ability of the kidneys to concentrate urine), failure to wake up completely when it is time to void, and (less commonly) a small bladder capacity.

How common is bedwetting in children who are daytime toilet-trained?

Most children are dry at night by 5 years old, but a significant minority still wet the bed. About 25% of 4 year olds and 10% of 7 year olds still wet the bed periodically. The resolution rate of nocturnal enuresis is about 15% annually, meaning that one in 6 kids who wets the bed become dry at night after a year. Up to 3% of adults wet the bed regularly.

At what age are most children able to control their bladder?

Most children are dry during the day and at night by 5 years old. Nighttime bowel control comes first, followed by daytime bowel control, then daytime urinary control, and finally nighttime urinary control.

Could something be wrong with my child’s bladder?

Everyone makes urine at night, and as the bladder fills, it sends signals to the brain that it is time to go to the bathroom. Usually, when these signals get very strong, it will cause the child to wake up. However, if the kidneys make a lot of urine at night, or if the bladder has particularly strong contractions, or if the child does not awaken easily, sometimes there is not enough time for the bladder to get the message to the brain that it is time to void, and instead the bladder empties. It is rare for children who have no problems other than bedwetting to have a structural or functional problem with the bladder; in children who were dry at night for at least 6 months and start bedwetting again, bladder abnormalities are a little more common than in children who were never dry, but they are still very rare.

What are your top three tips for helping children who wet the bed?

When patients come to see us for bedwetting, we always recommend optimizing elimination habits during the day as well as the night. This means drinking lots of water (usually at least one ounce per pound per day, but limiting fluids 2 hours before bedtime), going to the bathroom to void first thing in the morning, last thing at night, and every two hours during the day, and having a soft (pudding-consistency) bowel movement every day. Many times improved voiding habits alone can help make bedwetting less frequent; in children who continue to have bedwetting despite improved voiding habits, other management options, like medications, can be considered.

Top three tips:

  1. Drink a lot (except right before bed).
  2. Pee a lot (and frequently!).
  3. Poop.

How can I help my child keep their bed dry?

There are several options for this, and it depends on the preference of each child. Some children prefer to wear an absorbable undergarment, while others prefer to use a washable mattress pad. Parents should try each one and see which their child prefers; usually older kids prefer the mattress pad, but this is a good time to give the child some control and see what his or her preference is. Older children should also have a readily available change of sheets so that if the bed is too wet to sleep in, they can change it themselves in the middle of the night.

Does bedwetting at this age emotionally affect my child?

There are many studies evaluating whether bedwetting affects self-esteem in children. Some of these studies suggest that children who wet the bed have lower self-esteem than children who are dry at night, while other studies suggest that this is not the case. In my experience, most children are less concerned with bedwetting than their parents are, and the bedwetting is a problem for children mainly when it begins to interfere with social events like sleepovers. Parents should be supportive of their child regardless of whether the bed is wet or dry in the morning, and absolutely should not get angry about bedwetting. I can’t emphasize how important it is for the parents and the child to understand and acknowledge that bedwetting is not a conscious choice; it’s not the child’s fault, and the child should not be blamed. It is a normal part of growing up.

How can I help my child cope with wetting the bed?

The most important thing parents can do is offer support and not be angry at their child. They should treat bedwetting like it is a normal part of growing up (because it is). Set a good example for your children: make sure you go to the bathroom and void frequently, drink lots of water, and limit fluids before bedtime. Stick to a bedtime routine where the child goes to bed every night at the same time and wakes up at the same time. Never blame your child for the bedwetting.

Courtesy of Pediatric Urology Team