Definition of Noctural enuresis (Bed-wetting)
Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don’t despair. Bed-wetting isn’t a sign of toilet training gone bad. It’s often just a normal part of a child’s development.
Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 6 or 7 isn’t cause for concern. At this age, your child may still be developing nighttime bladder control.
If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting.
Symptoms of Noctural enuresis (Bed-wetting)
Bed-wetting is involuntary urination while asleep.
Most kids are fully toilet trained by age 4, but there’s really no target date for developing complete bladder control. By age 5, bed-wetting remains a problem for only about 15 percent of children. Between 8 and 11 years of age, fewer than 5 percent of youngsters are still wetting the bed.
When to see a doctor
Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.
Consult your child’s doctor if:
- Your child still wets the bed after age 6 or 7
- Your child starts to wet the bed after a period of being dry at night
- The bed-wetting is accompanied by painful urination, unusual thirst, pink urine or snoring
No one knows for sure what causes bed-wetting, but various factors may play a role.
- A small bladder. Your child’s bladder may not be developed enough to hold urine produced during the night.
- Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
- A hormone imbalance. During childhood, some kids don’t produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
- Stress. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
- Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, bloody urine and pain during urination.
- Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child’s breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, and daytime drowsiness.
- Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
- Chronic constipation. A lack of regular bowel movements may make it so your child’s bladder can’t hold much urine, which can cause bed-wetting at night.
- A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child’s neurological system or urinary system.
Several factors have been associated with an increased risk of bed-wetting, including:
- Sex. Bed-wetting can affect anyone, but it’s twice as common in boys than girls.
- Family history. If both of a child’s parents wet the bed as children, their child has an 80 percent chance of wetting the bed, too.
- Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.
Complications of Noctural enuresis (Bed-wetting)
Although frustrating, bed-wetting without a physical cause doesn’t pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.
Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.
Preparing for your appointment
You’re likely to start by seeing your family doctor or your child’s pediatrician. However, he or she may refer you to a doctor who specializes in urinary disorders (pediatric urologist or nephrologist).
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms, including any that may seem unrelated. It can also be helpful to keep a diary of your child’s bathroom visits. Write down when your child goes to the toilet, as well as whether or not he or she felt a sense of urgency to urinate. Also make note of how much your child has had to drink, especially after dinner.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that your child is taking.
- Write down questions to ask your child’s doctor.
Your time with your child’s doctor may be limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For bed-wetting, some basic questions to ask your doctor include:
- What’s causing my child to wet the bed?
- When might he or she outgrow wetting the bed?
- What treatments are available, and which do you recommend?
- Are there any side effects?
- Are there any alternatives to the primary approach that you’re suggesting?
- Are there any drinking or dietary restrictions that my child needs to follow?
- Is there a generic alternative to the medicine you’re prescribing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- Is there a family history of bed-wetting?
- Has your child always wet the bed, or did it begin recently?
- How often does your child wet the bed?
- Does the bed-wetting seem to be triggered by certain foods, drinks or activities?
- Is your child dry during the day?
- Is your child facing any major life changes or other stresses?
- Does your child complain of pain or other symptoms when urinating?
- If you’re divorced, does your child live in each parent’s home and does the bed-wetting occur in both homes?
What you can do in the meantime
Try to be patient and understanding with your child. Bed-wetting is a source of anxiety and frustration for your child. He or she isn’t wetting the bed on purpose. While you’re waiting to see the doctor, try limiting the amount your child drinks in the evening.
Tests and diagnosis
Your child will need a physical exam. Depending on the circumstances, urine tests may be done to check for signs of an infection or diabetes. If the doctor suspects a structural problem with your child’s urinary tract or another health concern, your child may need X-rays or other imaging tests of the kidneys or bladder.
Treatments and drugs
Most children outgrow bed-wetting on their own. If there’s a family history of bed-wetting, your child will probably stop bed-wetting around the age the parent stopped bed-wetting.
Generally, your child will be your doctor’s guide to the level of necessary treatment. If your child isn’t especially bothered or embarrassed by an occasional wet night, home remedies may be the ideal treatment. However, if your grade schooler is terrified about wetting the bed during a sleepover, he or she may be more motivated to try additional treatments.
These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child’s pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.
If you try a moisture alarm, give it plenty of time. It often takes at least two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does.
As a last resort, your child’s doctor may prescribe medication to stop bed-wetting. Various types of medication can:
- Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. Although DDAVP has few side effects, the most serious is the potential for seizures. This can happen if your child drinks too much when taking the medication. For this reason, don’t use this medication on nights when your child drinks a lot of fluids. Additionally, don’t give your child this medication if he or she has a headache, has vomited or feels nauseous.
- Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.
- Change a child’s sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child’s sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has been associated with mood changes and sleep problems. Caution is essential when using this medication, because an overdose could be fatal. Because of the serious nature of these side effects, this medication is generally recommended only when other treatments have failed.
Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn’t cure the problem. Bed-wetting typically resumes when the medication is stopped.
Lifestyle and home remedies
Here are changes you can make at home that may help:
- Limit how much your child drinks in the evening. Having around 8 ounces of liquid to drink (about .25 liter) in the evening is generally enough, but check with your doctor to find out what’s right for your child. There’s no need to limit how much your child drinks, but some experts feel a good rule of thumb is for children to have 40 percent of their liquids between 7 a.m. and noon, another 40 percent between noon and 5 p.m., and just 20 percent of their daily fluids after 5 p.m. However, don’t limit fluids if your child is participating in sports practice or games in the evenings.
- Avoid beverages and foods with caffeine in the evening. Caffeine may increase the need to urinate, so don’t give your child drinks, such as cola, or snacks that have caffeine, such as chocolate, in the evening.
- Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it’s OK to use the toilet during the night if needed. Use small night lights, so your child can easily find the way between the bedroom and bathroom.
- Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate once every two hours, or at least enough to avoid a feeling of urgency.
- Treat constipation. If constipation is a problem for your child, your doctor may recommend an over-the-counter stool softener.
Many people are interested in trying alternative therapies to treat bed-wetting, and several therapies, such as hypnosis and acupuncture, appear to be somewhat effective. However, other therapies currently don’t have evidence to support their use.
- Hypnosis. Small trials of hypnosis coupled with suggestions of waking up in a dry bed or visiting the toilet in the night found that this therapy may help some children stay dry throughout the night.
- Acupuncture. This treatment involves the insertion of fine needles in specific parts of the body. Acupuncture may be effective for some children.
- Diet. Some people believe that certain foods affect bladder function and that removing these foods from the diet could help decrease bed-wetting. More study is needed.
- Chiropractic therapy. The idea behind chiropractic therapy is that if the spine is out of alignment, normal bodily functions will be affected. However, there’s little evidence regarding the use of chiropractic therapy for the treatment of bed-wetting.
- Homeopathy and herbs. Although some people are interested in homeopathic remedies and herbal products, none of these has been proven effective in clinical trials.
Be sure to talk to your child’s doctor before starting any alternative therapy. Some treatments can be just as powerful as prescription medications or surgeries. Make sure the alternative therapies you choose are safe for your child and won’t interact with other medications your child may take.
Coping and support
Children don’t wet the bed to irritate their parents. Try to be patient as you and your child work through the problem together.
- Be sensitive to your child’s feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past.
- Plan for easy cleanup. Cover your child’s mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy.
- Enlist your child’s help. Perhaps your child can rinse his or her wet underwear and pajamas or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
- Celebrate effort. Don’t punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents.
With reassurance, support and understanding, your child can look forward to the dry nights ahead.