Bedwetting in children is a common problem that can frustrate parents. When children below five years wet their beds, it is a normal occurrence. But, the condition, also referred to as nighttime incontinence or nocturnal enuresis becomes a problem when potty-trained children suffer from it. Due to the condition, a child involuntarily urinates in their bed while sleeping. When the problem occurs after the age when staying dry at night is expected from the child, it can make parents anxious. Soggy pajamas and an embarrassed child are a common sight in many homes. While it is nothing to feel anxious, you may feel the toilet training is not as effective. Until the age of seven nighttime incontinence is not a concern as your child still develops the bladder control during nighttime.
When nighttime incontinence in your child continues after seven years, you need to deal with the issue with patience. Lashing out at your child may not offer the desired results. When you take the best steps after understanding the problem, then you can see reduced nighttime incontinence. Read ahead to know the lifestyle changes and other techniques to overcome the embarrassing situation.
Symptoms Of Bedwetting In Children
Most kids are toilet trained by the age of five, but you have no specific target date for complete bladder control. It is because each child is different from the other. But, some children can face the problem after they are five years. Some children can rectify it by the time they reach seven years. It is not the case with others as a small number of children wet their beds at night during sleep. If nighttime incontinence occurs frequently, then it is a cause of concern for parents.
Types Of Bedwetting In Children
Are there multiple types of nighttime incontinence in children? Yes, you can classify bedwetting in children into two types:
Primary Bedwetting In Children
Primary nocturnal enuresis is a condition occurring in children who have never remained dry throughout the night for six months in a row or longer.
Secondary Bedwetting In Children
It is the condition occurring in children when they start wetting their bed again after staying dry for six months or more. This condition is common among children who suffer from any medical or psychological condition.
See A Doctor For Bedwetting In Children
Most children outgrow nighttime incontinence on their own. But, others need extra help to overcome the problem. Some children suffer from some underlying health condition. So, it is important to seek medical attention when the child
- Wets the bed after they are seven years of age
- When the child starts wetting the bed a few months after they remain dry at night
- Along with peeing on the bed, the child suffers from other signs like increased thirst, painful urination, pin/red urine, snoring or hard stools
Causes Of Bedwetting In Children
The exact reason why your child wets the bed remains unclear. But, doctors believe several factors can play a key role in nighttime incontinence. The factors are:
A Small Bladder
A child’s bladder, small in size cannot hold enough urine produced when they sleep. It occurs due to insufficient development.
Inability To Recognize Full Bladder
Some children suffer from the problem due to their body not recognizing a full bladder. It occurs due to the inability of the nerves controlling the bladder to mature properly. The slow maturing of the bladder makes it impossible for the child to wake up at night when they have a full bladder. It is specifically true when the child sleeps deeply.
Hormone Imbalance
Children who suffer from hormonal imbalance can result in nighttime incontinence. It is prominent in kids who cannot produce enough ADH (Anti-diuretic hormone), which slows down the urine production at night.
Urinary Tract Infection
When your child suffers from UTI, it becomes difficult to control their bladder. So, the infection can result in the following symptoms:
- Bed-wetting
- Frequent urination
- Daytime accidents
- Red/pink urine
- Feel pain during urination
Sleep Apnea
Children suffering from sleep disorders like obstructive sleep apnea can suffer from the condition. Sleep apnea refers to the condition where your child’s breathing can get interrupted during their sleep. It happens mainly due to enlarged or inflamed adenoids or tonsils. They also feel drowsy during the daytime and snore while sleeping.
Diabetes
Children who develop type 1 diabetes can suffer from nighttime incontinence. A child who is dry at night, for several nights and suddenly wets their bed, it indicates something is amiss. If you see other signs like weight loss despite having a good appetite, fatigue, increased thirst, or passing large amounts of urine at once may indicate diabetes.
 Chronic Constipation
The urine and stool elimination is controlled by the same muscles. So, when the child suffers constipation for a long time, these muscles can become dysfunctional. It results in bedwetting in children at night.
Structural Problem Triggering Bedwetting In Children
When your child suffers from structural problems in their nervous system of the urinary tract, then it results in nighttime incontinence. In rare cases, the condition occurs due to a defect in the urinary system or neurological system of the child.
Sexual Abuse
In some cases, children suffering from sexual abuse can exhibit signs of nighttime incontinence. So, parents need to observe their children for other signs. If such incidents occur, children begin to wet their beds after they have learned to stay dry during the night. Such children can also show the following signs:
- Vaginal pain (in girls)
- Itching
- Frequent urinary tract infections
- Unusual discharge
- Sexually transmitted disease
Risk Factors Associated With Bedwetting In Children
Some factors can trigger the condition in some children more compared to others. The risk factors affecting the occurrence of nighttime incontinence are:
Sex
The condition is common in boys compared to girls.
Stress
When a child suffers from stress and anxiety, they can wet their bed at night. It is more common when the child experience stressful events like bullying, starting a new school, become a big brother/sister or sleep away from home. These events can trigger bed-wetting.
Family History
A family history with one or both parents suffering from nighttime incontinence in their childhood can make their children prone to the condition.
ADHD (Attention-deficit/hyperactivity disorder)
Children who suffer from ADHD
Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.
Diagnosis Of Bedwetting In Children
When you observe frequent nighttime incontinence in children, it is important to see a pediatrician. It is to eliminate the presence of any underlying medical condition or uncovering the actual cause of the problem. So, based on the circumstances, the doctor recommended one or all of the following tests:
Physical Examination
A detailed physical examination is performed by the doctor. During the assessment, the doctor asks questions regarding the medical history of the child. The doctor will also discuss the symptoms, the fluid intake of the child, the family history, bowel, as well as, bladder habits. During the examination, the doctor discusses the problems associated with nighttime incontinence.
Urine Tests
Your child’s urine sample is provided for testing. It is to check for the signs of infection or type 1 diabetes.
Imaging Tests
Your child needs to undergo different imaging tests to detect the exact cause. The tests suggested by the doctor to determine the cause of bedwetting in children are:
Renal Bladder Ultrasound
It is the imaging test used to determine the size and shape of the organs like the kidney as well as the urinary bladder. The imaging tests will also help the doctor detect any stone, mass, cyst, or other obstruction triggering the problem in your child. This test will detect any abnormalities.
Voiding Cystourethrogram (VCUG)
It is the x-ray examination used to detect any reverse urine flow into your child’s ureters and kidneys. During the test, the doctor inserts a catheter into the urinary tract to detect the problem.
Urodynamics Study
It is the test used to assess the function of your bladder during different stages. The test also evaluates the urethral sphincter function during the stages like urinary bladder filling and emptying. During the test, your doctor catheterizes the bladder and fills it with a warm saltwater solution to check the functioning.
 Complications Associated With Bedwetting In Children
While bedwetting in children without any underlying health condition may not cause any serious health complications, it can create some issues. Children who continue to wet their beds can suffer from the following issues:
Guilt And Embarrassment
Frequent nocturnal enuresis can make the child feel ashamed and guilty. This can result in significant impairment of self-esteem. At a younger age, a good self-image is important for the development of the child’s personality. Due to feeling guilty and embarrassment, your child’s self-image will take a hit. Low self-esteem results in difficulty to cope up with failure. This results in doing poorly in their life.
Loss Of Social Activities
A child who wets his/her bed at night can suffer from loss of opportunities to connect with others through social activities. So, they miss out on camping or sleepovers.
Rashes on the child’s bottom and genital area — especially if your child sleeps in wet underwear
Treatment For Bedwetting In Children
While bedwetting in children is a common problem, most children outgrow the issue on their own. They need no specific treatment to overcome the condition. But, some children continue to wet their beds over five years of age. Frequent wetting of the bed is a problem you must never ignore. So, you need to see a pediatrician to identify the underlying problem and work the best solution depending on the situation.
Home Remedies
The first step is to make the child aware of the problem and make them understand its seriousness. The lifestyle and home remedies section have detailed steps that will address the issue. Small changes like avoiding caffeine or limiting fluid intake in the evening can show results. But, some children may not show progress with the home remedies. In such cases, the doctor suggests additional treatment.
Address Underlying Emotional Problem
In some children, a stressful event in their life can result in nighttime incontinence. This can occur due to conflict at home or at school. The emotional issues can lead to a nightly accident. The following stressful situation can affect the mental health of your child, resulting in nightly accidents:
- Birth of a new sibling
- Changing homes
- Frequent changes in their routine
Talk To Your Child
It is important to talk to the child about how they are feeling. Compassion and understanding will help the child assess their situation and take proactive action. With your encouragement, they can put an end to nighttime incontinence.
Avoid Punishments
You need to avoid punishing the child for the social incontinence incidents. Having an open mind and communicating with the child can help them feel better. With reassurance, they will eventually overcome the problem.
Make Them Responsible
Making the child feel responsible will help them rein the problem. So, parents can try to keep a change of dress, and a dry towel by the bed for the child to change after they wake up will make them take responsibility for the action. It will limit social incontinence.
You need to work together with the child to create a nurturing as well as a supportive environment for the child to kick the habit.
Treatment For Medical Condition
A child overcomes the condition and stays dry for at least six months but start wetting the bed again indicates some problem. If your child develops new symptoms or cannot overcome nighttime incontinence within a week, then you need to talk to the doctor. Some underlying health issues like constipation, Type 1 diabetes, or sleep apnea can result in nighttime incontinence. So, as the first step, your doctor addresses the health issues before suggesting any other treatment.
Use Moisture Alarms
As the name suggests, it is the small device, operated using a battery. You can buy it without a prescription from most of the pharmacies. You can connect it to your child’s bedding or pajamas pad. Due to the moisture-sensitive nature of the pad, it senses wetness and the alarm will go off. In the ideal case, the alarm will start sounding as soon as the child starts to urinate. So, it helps your child wake up, which in turn will stop the urine stream. So, it gives time for your child to go to the toilet and urinate. But, if your child sleeps soundly, then another person needs to listen to the sound of the alarm and wake up the child.
When you try the moisture alarm, you need to give it ample time to show effectiveness. In most cases, the alarm may take up to three months to see any response in children. It takes at least sixteen weeks to see constant dry nights. Moisture alarms are effective in children as it carries a low risk. It does not cause any side effects or result in relapse. It offers a better long-term solution compared to using medication. But, you need to talk to your insurer regarding the insurance coverage. Some insurance providers may not offer coverage.
Medication To Overcome Bedwetting In Children
When all the other methods fail, then your doctor ill suggest prescribing medication. It is only suggested for a short period to stop the child from wetting the bed. The following medications are prescribed to deal with the condition.
Slow Urine Production During Night
Medications like DDAVP (desmopressin drug) will reduce urine production at night. But, parents need to provide medications with less liquid. It is because drinking too much liquid will only cause more problems. This medication is not suggested for children when they suffer from nausea, diarrhea, or fever. Always follow the instructions suggested by the doctor while using the drug. This medication is usually given as an oral tablet. It is only suggested for children above five years of age. Earlier, doctors used to prescribe other forms of desmopressin like nasal sprays. But, the side effects associated with the condition have resulted in discontinuing the other forms of treatment.
Calm The Bladder
In some cases, children wet their beds due to having a small bladder. So, the doctor prescribes an anticholinergic drug. Medications like oxybutynin (Ditropan XL) can reduce the contraction of the bladder and it increases the bladder capacity. This medication is specifically ideal for children experiencing daytime wetting. The medication is often along with other drugs for effective results. Usually, the doctor recommends it when other treatment options have failed.
In most cases, doctors prescribe a combination of medication to see effective results. But, these options have no guarantees. So, some may work and others may not. Also, medication will never cure the problem. It is observed that children on medication resume nighttime incontinence when the medication is stopped. The age the problem resolves may vary from one child to another. So, parents need to take proactive steps at home to encourage the child to stop the behavior. With patience, you can help the child overcome the issue.
Lifestyle And Home Remedies To Overcome Bedwetting In Children
Is it possible to overcome bedwetting in children by taking some steps at home? Yes, if your child has no underlying disease leading to the problem, then you can take the necessary steps to handle nocturnal enuresis. Make the following changes at home:
Limit Fluid Intake In The Evening
You need to limit giving your child fluids in the evening. While it is necessary to get enough fluids to avoid dehydration, there is no specific limit of fluid intake in children. So, try to encourage your child to drink liquids in the morning and early afternoon. Limit fluid intake after late afternoon. But, if your child participates in sports activities or other games that makes them thirsty in the evening, then try to limit fluid intake.
Avoid Caffeine
Children must avoid beverages or food containing caffeine as it has the potential to stimulate the bladder. So, discourage beverages containing caffeine at any time of the day, especially in the evenings. Why does caffeine stimulate your bladder? It is because it is a diuretic. So, it increases the urination frequency.
Encourage Double Voiding
You need to encourage your child to urinate before bedtime and go to the toilet just before they are going to fall asleep. This is referred to as double voiding. Double voiding is an effective technique to empty the bladder before the child sleeps. The technique involves passing more urine each time the child goes to the toilet. So, no urine is left in the bladder, which can lead to nighttime incontinence.
Encourage Toilet Use
You need to encourage your child to use the toilet throughout the day. So, you need to suggest the child use toilet during the day as well as night. Making them empty their bladder every two hours or so will avoid any feeling of urgency. Also, remind your child they need to use the toilet at night if necessary. To avoid the fear of going to the toilet at night, you need to install small night lights. It will help them find their way to the bathroom from the bedroom.
Create An Incentives Chart
You need to consider offering a positive incentive to your child to avoid nighttime incontinence. The positive incentive can work on the subconscious level, which will help the child to overcome the problem. For example, you can make a grid chart or use the calendar to present your child with a happy face or shiny star on the nights he/she stays dry. When the child earns at least ten such stickers, you need to gift them with a toy or treat. In some cases, a child may take longer to accomplish this, you need to remain patient and encourage them to achieve the milestone. This positive suggestion works for some children. But, it does not mean you need to punish the child when he wets the bed.
Address Underlying Problem
Some children wet their bed at night due to some underlying problem. Emotional problems like stress or anxiety can result in such behavior. So, as parents, you need to ensure the mental well-being of your child. Observe to know if your child requires targeted help other than the regular intervention for nighttime incontinence.
Get A Waterproof Mattress
Think about investing in a waterproof mattress to avoid any issue until the child learns not to wet his/her bed. It is one of the simpler methods you can try. Ensure you have a waterproof mattress pad or cover. It is also important to lay fresh clothes for your little one to change quickly in the middle of the night. If your child fails to wake up after wetting the bed and sleeps through the night, then you need to involve them in changing the sheets. If you make them do this, then it will help them feel responsible for wetting their bed.
Prevent Rashes
While you take steps to prevent your child from wetting their bed, it is also important to take necessary precautions to avoid complications caused to moisture retention in wet underwear. It can result in the development of a rash. So, you need to help your child rinse their bottom as a well genital area in the morning. It is also important to cover the affected with a protective cream or ointment at night. It acts as a barrier and prevents skin issues. You can talk to your pediatrician regarding product recommendations.
Conclusion
Bedtime wetting in children is one of the biggest challenges parents can face. It is because they need to wake up at an untimely hour to change the sheets and dress of the child. It makes parents tired and frustrated when they wake up in the morning. Most parents find it difficult to control their emotions and lash out at the child. It can only result in more harm than good. Staying neutral and containing what they feel internal is the right approach. Focusing on the positive instead of blaming or shaming the child is important to avoid the problem from affecting in the future. With a negative reaction, the child starts having such accidents out of defiance. Working together with the child is essential to overcome the problem and avoid complications.