Bedwetting Questions and Answers

Howard J. Bennett, MD

How common is bedwetting?

Bedwetting is a common condition that affects five million children in the United States. More importantly, bedwetting is one of those “hidden” problems of childhood. Because people do not talk about it outside the family, most children (and some parents) think they are the only ones with the problem.

How is bedwetting defined?

Bedwetting is divided in two groups. Primary bedwetting refers to children who have never been consistently dry at night. Secondary bedwetting refers to children who were dry for at least six months before they started wetting again. Because nighttime wetting is common in young children, doctors don’t diagnosis a child as being a bedwetter until he reaches six years of age.

Does bedwetting run in families?

Most children who wet the bed have at least one parent or another close relative who had the same problem as a child.

Why do children wet the bed?

Bedwetting is due to a maturational delay in the way the brain and bladder communicate with each other at night. There are three main factors that contribute to the problem.

Bladder size. Children who wet the bed usually have bladders that are smaller than their peers. This causes them to urinate more frequently during the day and their bladder has less room to “hold” urine at night.

Nighttime urine production. The brain produces a hormone at night that reduces the amount of urine the kidneys make. Some children who wet the bed produce less of this hormone and thereby produce more urine while they sleep.

“Deep” sleep. Some children have difficulty waking up at night in response to internal or external stimuli. As a result, the brain may not respond when the bladder signals that the child needs to urinate.

Do medical disorders cause bedwetting?

If a child has primary bedwetting, a medical problem is unlikely to be the cause of the wetting. However, if a child has secondary bedwetting, a medical problem may be the culprit. Disorders that can cause bedwetting include urinary tract infections, diabetes, sickle cell disease, snoring that interferes with a child’s breathing, and certain neurological disorders. These conditions can be readily be identified for by your doctor.

Another factor, which is often overlooked by doctors and parents alike, is constipation. Because the rectum is located behind the bladder, constipation can interfere with bladder emptying or the way the bladder signals the brain that a child needs to go. This can lead to both daytime and nighttime wetting episodes.

Do psychological problems cause bedwetting?

Although children may start wetting the bed after an episode of emotional stress, psychological problems are not responsible for primary bedwetting. Examples of stressful situations that can trigger secondary bedwetting include moving to a new home, changing schools or the death of a loved one. The wetting usually resolves when the stress passes.

Does bedwetting go away on its own?

After the age of six, 15% of children who wet the bed become dry every year with no intervention. Although children usually follow the same pattern as family members, this is not always the case. Because there is no way to predict when a child will overcome his wetting, it is important to address the problem once he is motivated to become dry.

How can I tell if my child is motivated to become dry?

There is no magic age when children are ready to deal with their bedwetting, however, most show some concern about the problem by the time they are seven. There are five signs you can look for to see if your child is ready to do the work necessary to become dry.

• He starts to notice that he’s wet in the morning and doesn’t like it.

• He tells you he doesn’t want to wear Pull-Ups anymore.

• He tells you he wants to be dry at night.

• He asks if you wet the bed when you were a child.

• He doesn’t want to go on sleepovers because he is wet at night.

Can I help my child avoid the negative feelings associated with bedwetting?

There a number of steps you can take to help children feel better about themselves.

• Do not punish or shame your child for being wet at night.

• Remind your child that bedwetting is no one’s fault.

• Let your child know that lots of kids have the same problem. However, because “five million” is such a large number, you will need an image children can understand. I use the following example in my office: If you invited 5 million children to see a professional baseball game, you would need 100 stadiums to find them all seats.

• Let your child know if you or anyone in the family wet the bed growing up.

• Make sure your child’s siblings do not tease her about wetting the bed.

• Maintain a low-key attitude after wetting episodes.

• Reinforce any efforts your child makes to help with her wetting, e.g. stripping the bed or helping you carry wet bedding to the laundry room.

• Praise your child for success in any of the following areas: waking up at night to urinate, having smaller wet spots, and having a dry night.

Does fluid restriction help children stay dry?

Some doctors believe that restricting fluids after dinner helps children stay dry. Although this helps some kids, it doesn’t work for most—if a child limits fluids, he may wet the bed with four ounces of urine instead of six, but he’s usually still wet. My approach to this issue is practical. If a child tells me that limiting fluids helps him stay dry, I give it my “okay.” Otherwise, I don’t recommend this approach because some children will see it as a punishment.

Does it help if parents take children to the bathroom before they themselves go to sleep at night?

Waking your child to go to the bathroom is called “lifting” because they are often carried or guided zombie-like to the toilet. Although this will help some children stay dry at night, it is a temporizing solution and does not actually teach them to be dry at night. That said, it is a simple method that can help until a child outgrows the problem or is ready to work on other methods to become dry.

What is the best way to treat bedwetting?

The most effective treatment for bedwetting is a product called the bedwetting alarm. Most bedwetting alarms are small, battery-operated devices that children wear to bed at night. The device teaches the child’s brain to pay attention to her bladder while she’s sleeping. Bedwetting alarms have two basic parts: (1) a wetness sensor that detects urine and (2) an alarm unit that produces a loud sound when a child wets the bed.

How does the bedwetting alarm work?

The alarm’s sensor has the ability to detect small amounts of moisture. When a child wets the bed, the urine in his underpants turns on the alarm. When the alarm goes off it awakens the child so he can go to the bathroom and finish urinating in the toilet. (In the beginning, most parents have to wake their child when the alarm goes off.) After weeks of hearing the alarm, the child’s brain learns to pay attention to the full bladder signals and he starts to wake up before wetting the bed. Interestingly, most children stop waking up at night to urinate over time. This happens because the bladder learns to hold all of its urine until morning.

Some alarms also have the ability to vibrate when they go off. This is a helpful feature because many children are more likely to wake up if they feel a vibration at the same time that the alarm starts to buzz.

How successful is the bedwetting alarm?

According to research, bedwetting alarms are successful 50% to 70% of the time. Programs that include other behavioral components have success rates in the 70% to 85% range. Most children become dry within two months of starting the program. Some do it sooner, and some aren’t completely dry until they’ve been doing the program for four months.

Because bedwetting alarms involve waking up at night, they work best if the child (and parents) are highly motivated to solve the problem.

Are there other methods to help children become dry?

Although the bedwetting alarm is the most effective device to help children become dry, there are other behavioral techniques that can be used alone or in combination with the alarm.

Motivational counseling. Research shows that children will be more invested in becoming dry if they are actively involved with the program. This means letting them help with all aspects of the treatment plan.

Dryness calendar. Children use this to record wet and dry nights and to monitor their progress. Younger children like to put stickers or stars on their calendar whenever they have a dry night.

Bladder exercises. In the past, doctors taught children to do bladder “stretching” exercises. This approach has fallen out of favor because these exercises are difficult to do and they are not particularly effective. Nowadays, bladder exercises consist of drinking more water during the day and teaching children to respond promptly when their bladder signals that they need to urinate.

• Waking up practice. This is an exercise that helps children learn to wake up at night if they can’t hold all of their urine until morning.

Are drugs an effective way to treat bedwetting?

There are a few medications available to treat bedwetting. The one that’s prescribed most often is called desmopressin (brand name: DDAVP). Desmopressin is a manufactured form of the hormone the brain produces to decrease urine production at night. It helps 50% of children who take it, though it appears to be less effective in children who have small bladders. The effects of desmopressin are not long lasting, and children usually relapse when the medication is stopped. For this reason, doctors generally recommend it for short-term use, i.e., sleepovers, vacations or special occasions. A 6-month course of desmopressin is worth considering in children who don’t become dry with the bedwetting alarm, but need some treatment that will get their wetting under control.

Should I encourage my child to go on sleepovers?

Deciding what to do about sleepovers creates a lot of anxiety for many children who wet the bed. The first question that needs to be addressed is whether the child wants to keep his bedwetting a secret or not. Children seven years and younger often don’t mind if their friends know they wear Pull-Ups at night. Older children are usually sensitive about this issue and don’t want anyone to know what’s going on. I devote an entire chapter in my book, “Waking Up Dry,” to sleepovers, including ways to use a Pull-Up in a sleeping bag.

Should I mention bedwetting at routine checkups?

According to a recent study, there is a significant communication breakdown between parents and doctors on this issue. While 82% of parents want healthcare providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves. Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at routine visits.

The reason doctors don’t ask about bedwetting is because they assume parents would bring it up if it were a concern. Therefore, parents should always ask for help if they have a child who is wet at night.

© 2012 Howard J. Bennett. All Rights Reserved.

(First published in Westchester Parent March 2007.)

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