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Symptoms of enuresis
Enuresis is when an older child (age 7 or older) wets the bed at night while sleeping. This could happen a few times a week or every night. Many kids who wet the bed are very deep sleepers. For most, urinating while sleeping is the only symptom.
What causes enuresis?
Bedwetting is not a mental or behavior problem. It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom. A number of things can cause bedwetting. Some of the more common causes include:
- Genetic factors (it tends to run in families).
- Difficulties waking up from sleep.
- Slower than normal development of the central nervous system. This reduces the child’s ability to stop the bladder from emptying at night.
- Hormonal factors. Not enough antidiuretic hormone is produced. This is the hormone that slows urine production at night.
- Urinary tract infections.
- Abnormalities in the urethral valves in boys or in the ureter in girls or boys.
- Abnormalities in the spinal cord.
- A small bladder.
When do most children achieve bladder control?
Children achieve bladder control at different ages. If a child is younger than 5 years of age, treatment for bedwetting is not necessary. Many children don’t stay dry at night regularly before age 7. Bedwetting up to that time is not unusual, even though it may be frustrating to parents. Call your family doctor if:
- Your child is 7 or older and wets the bed 2 to 3 times a week.
- Your child is 5 or older and experiences daytime and nighttime wetting.
How is enuresis diagnosed?
Most children who wet the bed are healthy. Your doctor can help you determine whether your child’s bedwetting is caused by a medical problem. First, your doctor will ask questions about your child’s daytime and nighttime bathroom habits. He or she will do a physical exam and probably a urine test to check for infection or diabetes.
Your doctor may also ask about how things are going at home and at school for your child. You may be worried about your child’s bedwetting. But studies have shown that children who wet the bed are not more emotionally upset than other children. Your doctor might also ask about your family life, because treatment may depend on changes at home.
In many cases, doctors can’t find the cause of bedwetting.
Can enuresis be prevented or avoided?
Enuresis cannot be prevented or avoided. It tends to run in families. It is not something the child can control, so they can’t avoid it.
Most children outgrow bedwetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine.
Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments you can try at home include:
- Limit fluids before bedtime.
- Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
- Use a moisture alarm system that rings when the bed gets wet. This can teach your child to respond to bladder sensations at night.
- Create a reward system for dry nights.
- Ask your child to change the bed sheets when he or she wets.
- Bladder training—have your child practice holding his or her urine for longer and longer times during the day. This helps stretch the bladder so it can hold more urine.
What kinds of medicines are used to treat bedwetting?
Your doctor may give your child medicine. This usually only happens if your child is 7 years of age or older and behavior therapy has not worked. Medicines are not a cure for bedwetting. One kind of medicine helps the bladder hold more urine. The other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.
Living with enuresis
Bedwetting can lead to behavior problems because a child may feel guilt and embarrassment. It’s true that your child should take responsibility for bedwetting. He or she could do this by helping with the laundry. But your child shouldn’t be made to feel guilty. It’s important for your child to know that bedwetting isn’t his or her “fault.” Punishing your child for wetting the bed will not solve the problem.
It may help your child to know that no one knows the exact cause of bedwetting. Explain that it tends to run in families. (If you wet the bed as a child, you should share that information with your child.)
Remind your child that it’s okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child’s mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.
Almost all kids who wet the bed stop eventually. Some even stop without treatment.
Questions to ask your doctor
- Should I be concerned about my child’s bedwetting?
- Why does he or she do it?
- What can I do to help him or her?
- Could there be a medical reason that my child wets the bed?
- What tests can you do for this?
- Will my child outgrow this, or should he or she be treated?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.