Bedwetting
Enuresis; Nocturnal enuresis
Bedwetting or nocturnal enuresis is when a child wets the bed at night more than twice a month after age 5 or 6.
Bedwetting affects over 5 million children in the United States over the age of 5 or 6. Before the age of 5 or 6, it's total normal for kids not to be dry totally at night. But once you reach 5 or 6, we call it bedwetting or enuresis. And unless you do something to intervene, there's a good chance it will still be there next year. In fact if you're over age 6 and you're bedwetting today, there's an 85% chance you'll still be bedwetting next year on this day unless you do something. I'm Dr. Alan Greene and I what to share with you something you can do. But first, you have to understand a little bit about what causes bedwetting. Children who wet the bed have 2 things in common. One is that they make more urine at night than their bladder will automatically hold. And 2, these children don't wake up when there's a signal from the bladder saying that it's full. There's lot of kids who don't wake up, who don't wet the bed because their bladders don't get so full. Lots of kids whose bladders get pretty full but don't wet the bed because they wake up fine. Bedwetters are the ones who do both. So one of the most powerful ways to break-in and to change that cycle is to teach kids to wake up at that moment when the bladder gets full. And bedwetting alarms are a great way to do it. Here is 1 model of one. It comes in 2 pieces. There is an alarm unit. Has a cool little magnet on the back that snaps in. Kids like to play with the magnet. And you put it in the pajamas up kind of near their head. The other end is an alligator clip that clips to the bottom part of the pajamas. And it's got a moisture sensor in it. This paper towel has a little bit of water on it like simulated pajamas. (Alarm ringing) And the alarm starts going off at the first sign of moisture. I'll turn that off so you don't have to put up with that while we finish talking about this. Hopefully. There we go. So what happens then is that the first sign of moisture, the alarm goes off. You can get varying volumes of alarms. Some as loud as a smoke alarm. But often the child will not wake up. Somebody else needs to wake them up. They will instantly clench up and stop peeing at the first few drops, which helps the laundry issue right away. But they need somebody else to come in, walk them to the bathroom. And they won't recognize you. They'll be in the middle of sleep, but they'll recognize the toilet and finish going. After a couple of weeks, kids will start to wake up with the alarm. After a few more weeks, they'll start to wake up just before the alarm. That signal that the bladder is getting full gets through to them. And a few more weeks, many of them won't wake up at all. The signal will make it up to the brain. It will send a signal back down to the bladder to hold it in for the rest of the night and be completely dry. It often takes 12 weeks, though. The 2 biggest complaints that I hear from people when they've starting using the alarm is they'll say, My child doesn't wake up. And that's normal. Bedwetters are very deep sleepers. In fact it often works better for those who don't wake up themselves to the alarm. The second big complaint I hear is, I've done it for 2 weeks and they're still bedwetting. It takes longer than 2 weeks. It often takes 6 weeks and sometimes even as long as 12 weeks. But it's a very effective way to do it.
Causes
The last stage of toilet training is staying dry at night. To stay dry at night, your child's brain and bladder must work together so your child wakes up to go to the bathroom. Some children develop this ability later than others.
Bedwetting is very common. Millions of children in the United States wet the bed at night. By age 5, over 90% of children are dry during the day, and over 80% stay dry through the night. The problem usually goes away over time, but some children still wet the bed at age 7, or even older. In some cases, children and even a small number of adults, continue to have bedwetting episodes.
Bedwetting also runs in families. Parents who wet the bed as children are more likely to have children who wet the bed.
There are 2 types of bedwetting.
- Primary enuresis. Children who have never been consistently dry at night. This most often occurs when the body makes more urine overnight than the bladder can hold, and the child does not wake up when the bladder is full. The child's brain has not learned to respond to the signal that the bladder is full. It is not the child's or the parent's fault. This is the most common reason for bedwetting.
- Secondary enuresis. Children who were dry for at least 6 months, but started bedwetting again. There are many reasons that children wet the bed after being fully toilet trained. It might be physical, emotional, or just a change in sleep. This is less common, but still not the fault of the child or parent.
While less common, physical causes of bedwetting may include:
- Lower spinal cord lesions
- Birth defects of the genitourinary tract
- Urinary tract infections
- Diabetes
Self-care at Home
Remember that your child has no control over bedwetting. So, try to be patient. Your child also may feel embarrassed and ashamed about it, so tell your child that many children wet the bed. Let your child know you want to help. Above all, do not punish your child or ignore the problem. Neither approach will help.
Take these steps to help your child overcome bedwetting.
- Help your child understand not to hold urine for a long time.
- Make sure your child goes to the bathroom at normal times during the day and evening.
- Be sure your child goes to the bathroom before going to sleep.
- It is OK to reduce the amount of fluid your child drinks a few hours before bedtime. Just do not overdo it.
- Reward your child for dry nights.
You might also try using a bedwetting alarm. These alarms are small and easy to buy without a prescription. The alarms work by waking children when they start to urinate. Then they can get up and use the bathroom.
- Bedwetting alarms work best if you use them every night.
- Alarm training can take several months to work properly.
- Once your child is dry for 3 weeks, continue using the alarm for another 2 weeks. Then stop.
- You may need to train your child more than once.
You may also want to use a chart or keep a diary that your children can mark each morning they wake up dry. This is especially helpful for children, ages 5 to 8 years old. Diaries allow you to see patterns in your child's habits that may help. You can also show this diary to your child's health care provider. Write down:
- When your child urinates normally during the day
- Any wetting episodes
- What your child eats and drinks during the day (including time of meals)
- When your child naps, goes to sleep at night, and gets up in the morning
When to Call Your Doctor
Always notify your child's provider of any bedwetting episodes. A child should have a physical exam and a urine test to rule out urinary tract infection or other causes.
Contact your child's provider right away if your child is having pain with urination, fever, or blood in the urine. These may be signs of an infection that will need treatment.
You should also contact your child's provider:
- If your child was dry for 6 months, then started bedwetting again. The provider will look for the cause of the bedwetting before recommending treatment.
- If you have tried self-care at home and your child is still wetting the bed.
Your child's provider may prescribe a medicine called DDAVP (desmopressin) to treat bedwetting. It will decrease the amount of urine produced at night. It can be prescribed short-term for sleepovers, or used long-term for months. Some parents find that bedwetting alarms combined with medicine work best. Your child's provider will work with you to find the right solution for you and your child.
References
Elder JS. Enuresis and voiding dysfunction. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2020:chap 558.
Leung AKC. Nocturnal enuresis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:1366-1368.
Lissauer T, Carroll W. Child and adolescent mental health. In: Lissauer T, Carroll W, eds. Illustrated Textbook of Paediatrics. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 24.
Version Info
Last reviewed on: 2/17/2024
Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
