Bedwetting is a common problem, and it often goes away as a child gets older. But if the problem persists, parents should not ignore it, says Paul F. Austin, MD, Director of the Pediatric Urology Basic Science Research Program at Texas Children's Hospital in Houston.
"We do not advise parents to let their child ‘wait it out,' especially when the child is 8 or older," he says. "Bedwetting affects a child's self-esteem and quality of life, and can prevent them from having sleepovers, going on field trips and doing other enjoyable activities."
There are two common bladder problems in children: nighttime bedwetting and daytime wetting, or incontinence. Children can have one or both conditions.
Nighttime bedwetting becomes less common as children get older. An estimated 15 percent of 5-year-olds wet their beds at night, compared with 5 percent of 10-year-olds. If a child over the age of 6 often wakes to a wet bed, speak to your child's doctor to explore the possible causes and solutions.
Some children have never been dry at night, and some start wetting the bed again after staying dry for 6 months. Bedwetting can have a number of causes, including:
- Family history (genetics) - half of children with nighttime bedwetting had a parent who also struggled with the problem.
- Slow development of brain-bladder control - a child who is a ‘deep sleeper' may not wake up to use the toilet.
- Smaller than expected bladder capacity.
- Making too much urine while asleep.
- Untreated diabetes.
Daytime wetting is generally caused by bladder problems, such as:
- Overactive bladder. The bladder squeezes without warning, causing frequent runs for the toilet and wet clothes.
- Underactive bladder. Your child uses the toilet only a few times a day, and has little urge to do so. Your child may have a weak or interrupted stream of urine.
- Disordered urination. The bladder muscles and nerves do not work together smoothly. Certain muscles cut off urine flow too soon, and urine left in the bladder may leak.
Diagnosing the Cause of Daytime or Nighttime Wetting
If you're concerned about your child's daytime or nighttime wetting, try to keep track of their bathroom habits in a diary. Note how often they urinate during the day and night and whether your child drinks fluids before bed.
The doctor will ask questions such as how often your child wets the bed; whether they have daytime symptoms like needing to urinate frequently or urgently; and whether they are unable to hold in their urine during the day.
A physical exam and lab tests will be done to rule out possible causes such infections, diabetes or kidney problems. The doctor may order a bladder scan, which is an ultrasound that shows how much urine is still in the bladder after urinating. The doctor may also order urodynamic testing, which checks how well the lower urinary tract stores and releases urine.
For daytime wetting, treatment depends on what is causing the problem. The doctor may recommend starting with bladder training, to help your child get to the bathroom sooner and help reset bladder systems that are not working together. This may include:
- Urinating every 2 to three hours (time voiding)
- Relaxation techniques (e.g. deep breathing)
- Urinating twice in one bathroom visit, to help empty the bladder completely
- Using biofeedback to coordinate and relax the pelvic floor muscles so children can fully empty the bladder. Special biofeedback sessions can retrain muscles to work together in the right order.
Dr. Austin gives children cartoon diaries with stickers for them to keep track of when they go to the bathroom. "We set up a schedule - usually mealtimes, bedtimes and times in between," he says. Older children may enjoy using an app to keep track of their bathroom schedule.
Teaching children deep breathing exercises can help them relax during bathroom visits. "We also talk about using certain postures in the bathroom to help bladder emptying," he says.
Because bladder and bowel problems often go together, Dr. Austin stresses the importance of getting enough fiber so kids aren't constipated.
For nighttime wetting, encourage your child to drink more in the morning or at lunchtime, and drink in the evening only if they're thirsty. Try to prevent them from drinking an hour or two before bed. Limit or stop them from drinking caffeinated and carbonated drinks like soda. These drinks may irritate the bladder or produce extra urine.
A bedwetting alarm may help. These alarms have a special sensor that detects moistures in pajamas or training pants, and triggers a bell or buzzer. The alarm wakes the child so they can get to the bathroom before having an accident. Eventually, the child learns to wake up when their bladder is full and get to the bathroom in time. The alarm may take three or four months of regular use before this happens.
The doctor may recommend medication if other treatments are not effective. The most common medication prescribed for bedwetting is desmopressin (DDAVP), which is available as a pill. It can be given an hour before going to bed and it will slow the amount of urine your child's body makes overnight, so the bladder does not overfill and leak.
Dr. Austin says it is important to remember that bedwetting is not the child's fault. Avoid punishing or teasing your child. "Your child needs your support to overcome nighttime or daytime wetting," he says. "It is important to understand that with time and maturation, children will overcome bedwetting-either on their own or with medical help."
Toilet Training Tips
There is no evidence that the age at which a child goes through toilet training raises or lowers their risk of bedwetting, Dr. Austin says. In general, most girls toilet train between the ages of 2 to 2 ½, while boys train between 2 ½ and 3. "Control of nighttime wetting is the last to be developed," he notes.
The best piece of advice he has for parents: "Manage your expectations-kids mature differently," Dr. Austin says. "Give your children encouragement and support, and follow their lead. They will let you know when they are ready." Be patient--toilet training can take between 3 and 6 months, or even longer for some children.
Remember that accidents will happen and shouldn't be punished. If your child has been potty-trained and starts having problems, talk to your doctor to rule out an infection. Likewise, if your child is 3 or older and you are concerned they are not yet potty trained, your doctor can offer advice to make the process easier.