Bedwetting: What to do (and not do) about it

Back by popular request: This column first ran January 28, 2015

Bedwetting is a common and well-known concern to many parents and children alike. It is quite normal for children under the age of seven to wet the bed on occasion. Children up to about age 10 can vary in their ability to control their bladders during nighttime sleep, and boys often take longer than girls to discontinue wetting the bed at night.

The medical terms for bedwetting are “nocturnal enuresis” and “nighttime incontinence.” Bedwetting is not a sign of failed toilet training. In fact, it is considered by most doctors as a normal part of childhood development.

Bedwetting can cause the child embarrassment, guilt and low self-esteem. It can also interfere with social activities such as sleepovers and overnight camping. The condition can also cause uncomfortable skin rashes. As a result, bedwetting should be handled with great care, understanding and patience. Children should never be punished for bedwetting.

What causes bedwetting?

There are many possible causes of bedwetting. It is quite common for children to wet the bed to age seven, and a small percentage of children will even wet the bed up to age 10. The two most common causes of nocturnal enuresis are having a small or immature bladder that cannot hold the urine all night, or the nerves that normally wake a child when the bladder is full have not matured enough to do an adequate job.

Fortunately, both of these conditions will improve over time to function normally. There are other rare causes including stress, emotional and family problems, and medical problems such as a urinary tract infection, constant constipation (the muscles that control defecation are also involved with urination), hormonal imbalances (including diabetes and diuretic hormones), and structural abnormalities with the bladder, kidneys and urination system.

Bedwetting is more commonly seen in boys, children whose parent wet the bed, and children with attention-deficit hyperactivity disorder (ADHD). 

How is bedwetting diagnosed?

Up until age seven, most children are still developing some portion of nighttime bladder control. If a child is still wetting the bed after age seven, it should be mentioned to the pediatrician for additional evaluation. Additionally, talk with your physician if the child has remained dry for months and the bedwetting resumes, or if the child complains of painful urination, increased thirst, discolored urine, or constipation.

The child’s doctor may request a medical examination. The doctor may check for signs of infections and diabetes or imaging studies to check the bladder and kidneys and urinary tract, in addition to other indicated tests. The doctor may review your family history of the problem and discuss if stress may be contributing to the condition.

Bedwetting treatments

The vast majority of children outgrow bedwetting on their own. If there is a family history of nocturnal enuresis, the child will probably stop bedwetting at approximately the same age that the parent did. The best approach, until the child outgrows bedwetting, is to use lifestyle modifications:

Limit how much your child drinks before bed. Discontinue liquids 1-2 hours before bedtime.

Encourage double voiding before bedtime. Have your child urinate 45 minutes before bedtime. Then have them urinate again immediately before they go to bed. 

Treat constipation. If constipation is a problem for your child, check with your pediatrician for best treatment options.

Prevent or treat skin rashes. Prolonged exposure to wet underwear can cause irritation and maceration. Have your child rinse every morning. It also may help to apply a protective moisture barrier ointment or cream before bed. Ask your doctor for product recommendations.

Use an absorbent undergarment.  For children with bedwetting problems, these have become life-changing, required tools. They are so thin that no one will know they have them on. This is terrific for overnight stays with friends, camps, and the regular embarrassment of having to change the bed linens. This is the most important strategy until the child outgrows the condition.

If lifestyle changes fail, medical reasons are ruled out as the cause, and medical intervention is indicated, there are medications that the pediatrician can prescribe that slow urine production at night, and others that calm a small bladder from being overactive during the night. Sometimes a combination of these works best. Your pediatrician will recommend what is best.

Summary

Children don’t wet the bed on purpose. They can’t help or control their bedwetting. A child should never be punished for bedwetting. Be sensitive, patient, understanding, encouraging and supportive. With time or medical treatment, the problem will resolve and dry nights will return.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.