Bed-wetting 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.
Bed-wetting 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 bed-wetting 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.
Children don't wet the bed on purpose. Most likely, a child wets the bed for one or more reasons, such as:
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.
Treatment usually is not needed for bed-wetting 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 bed-wetting 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 bed-wetting is caused by a treatable medical problem, such as a bladder infection, the doctor will treat that problem.
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:
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:
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 bed-wetting as a child.
Most cases of primary nocturnal enuresis are not caused by any medical condition. But secondary nocturnal enuresis, which is bed-wetting 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 bed-wetting.
Bed-wetting 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, bed-wetting may be a symptom of some other medical condition. Call the doctor if your child has any of these symptoms.
Bed-wetting 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 —bed-wetting 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 bed-wetting, treating the condition may stop the wetting.
Treatment often does not completely stop bed-wetting, but it may reduce how often it occurs. Although bed-wetting may return when treatment is stopped, repeating or combining treatments may have longer-lasting results.
Sometimes bed-wetting is related to emotional stress. Bed-wetting usually stops when the stress is relieved or managed.
The emotional responses to bed-wetting can impact the relationship with your child. If you or your child is having difficulty with handling bed-wetting, 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.
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.
Call your doctor if:
Watchful waiting is okay if bed-wetting 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 bed-wetting starts after a child has had bladder control for a period of time. Look for possible stresses that might be causing the bed-wetting. Bed-wetting may stop when your child's stress is relieved or managed. If it doesn't, your child should see a doctor.
A medical history and a physical exam are also part of a medical evaluation of bed-wetting. If you are having your child evaluated for bed-wetting, 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:
If a child has uncontrollable wetting both at night and in the day, other tests may need to be done.
Most children gain bladder control over time without any treatment. Bed-wetting 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 bed-wetting 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 bed-wetting is based on the:
Treatment for bed-wetting may include:
Treatment may be helpful if bed-wetting 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.
For more information, see:
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.
Treatment for bed-wetting 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.
Counseling (psychotherapy) may be helpful for the child who has secondary enuresis or for bed-wetting that is caused by emotional stress. Psychotherapy involves talking with a trained counselor. The counselor 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.
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 bed-wetting 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 bathroom if needed.
Most children gain bladder control over time without any treatment. A child should first be allowed to overcome bed-wetting 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 bed-wetting:
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.
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 bed-wetting. These prescription medicines may be used to control bed-wetting for a little while. They don't completely stop it.
In a few cases, when a small bladder capacity or overactive bladder is thought to be the cause of bed-wetting, oxybutynin (such as Ditropan or Oxytrol) may be used to treat bed-wetting, especially when the child also has daytime accidental wettings.
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:
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.
Other Works Consulted
- Foreman JW (2011). Kidney or urinary tract disorders. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 1691–1696. New York: McGraw-Hill.
- Graham KM, Levy JB (2009). Enuresis. Pediatrics in Review, 30(5): 165–173.
- Huang T, et al. (2011). Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews (12).
- Mikkelsen EJ (2007). Elimination disorders: Enuresis and encopresis. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 655–669. Philadelphia: Lippincott Williams and Wilkins.
- Sadock BJ, Sadock VA (2007). Elimination disorders. In Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1244–1249. Philadelphia: Lippincott Williams and Wilkins.
- Tanagho EA (2008). Disorders of the bladder, prostate, and seminal vesicles. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 574–588. New York: McGraw-Hill.
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