Fewer things are more embarrassing for a child than wetting to bed after they have been potty trained. While this condition is not dangerous in and of itself, it can indicate an underlying medical condition which requires treatment – or just be a matter of a small or underdeveloped bladder! Read on to learn more about bedwetting, including what medical conditions can potentially cause it and what kinds of treatments help.

Bedwetting Defined

Bedwetting is also called nighttime incontinence or enuresis and while some children will rarely (if ever) struggle with this problem, for some it can be a major challenge to overcome.

Signs and Symptoms of Bedwetting

This condition is marked by periods in which a child will involuntarily urinate when they are asleep.  While most children are fully potty trained by age 5, some children will still have episodes of bedwetting between the ages of 5 and 7. A small number will have problems with it beyond seven years of age.

What Causes Bedwetting?

Bedwetting is divided into two broad categories – primary bedwetting and secondary bedwetting – depending on the underlying problem.

Primary bedwetting refers to a child that has always wet to bed (rather than a child who stopped wetting to bed and then started up again).  It can be caused by a number of issues, including:

  • The child is producing too much urine at night.
  • The child’s bladder is not large and/or strong enough to hold the urine.
  • The child is not awakened by nighttime signals that his/her bladder is full.
  • The child has poor daytime toilet habits, such as not going to the bathroom often enough.

Primary bedwetting, in short, is considered to be a developmental challenge rather than being caused by some other medical condition.  This represents the vast majority (around 99%) of bedwetting cases.

Secondary bedwetting usually happens when a child has been dry at night for a period of time (weeks, months or years) and then suddenly starts bedwetting again.  This is usually caused by some sort of underlying condition or phenomenon, with the most common culprits including:

  • A urinary tract infection. In this case, bedwetting will often be accompanied by a child complaining of painful urination, having to go to the bathroom all the time and may also bring on a fever and episodes of nausea and vomiting.
  • Diabetes. Children who have bedwetting episodes in which large amounts of urine are produced, seem to complain about being thirsty all the time and also are tired or have lost weight without any explanation should be screened for diabetes.
  • Chronic constipation. Many of the same muscles that control defecation will control urination, too, and if a child is constipated all the time, this can lead to dysfunction of these muscles – and poor bladder control.
  • Hormone imbalances. Some children do not make enough antidiuretic hormone, which can cause them to produce more urine at night while they are sleeping.
  • Physical abnormality. A child may also problems with bedwetting because they have some sort of abnormality in the structure of their urinary tract.

Risk Factors for Bedwetting

While any child can have a problem with bedwetting, this is more likely to occur in children who are:

  • Boys
  • Have a family history of bedwetting
  • Have ADHD

Complications from Bedwetting

Thankfully, bedwetting is not dangerous for your child – though, as noted above, it can be a sign of an underlying medical condition which needs to be treated.  However, there can be other unwanted complications, such as:

  • Emotions of guilt, embarrassment, shame
  • Resulting low self-esteem
  • Reluctance to go to sleepovers, camp or other overnight activity
  • Rash or other skin irritation

Testing/Diagnosing Bedwetting

Diagnosis will of course be primarily based on reports of the parent of nighttime incontinence. However, a doctor suspects that this might be due to some sort of secondary problem, they might do urine testing (which can help diagnose problems like a urinary tract infection or diabetes) or imaging tests like ultrasounds (which can diagnose structural abnormalities in the urinary tract).

Treatment for Bedwetting

Most parents – and kids! – will be relieved to hear that primary bedwetting (the most common form) will resolve on its own as children grow and their bladders enlarge and become stronger. In other words, this is a problem that will usually go away on its own.  However, parents who want to help this along can try several different methods, including:

  • Treatment of any underlying conditions that might be contributing to the bedwetting, such as giving a child antibiotics to resolve a UTI
  • A moisture alarm, a padded, moisture-sensitive device which will be laid on the bed (most will fit under the sheets and which is attached to an alarm device which will go off if its senses moisture. Parents should be aware, however, that using this device can take up to six weeks to help the problem, so do not expect results very quickly!
  • There are some medications available that can help with this problem as well, including desmopressin (which raises the levels of antidiuretic hormone so that a child will not produce as much urine at night) and Ditropan (which prevents bladder muscle spasms). These can be used separately or together. However, some doctors will not want to prescribe these if the child’s bedwetting is a developmental problem which they will outgrow: like all medications, they have potential side effects.

At-Home Support

There are also several lifestyle changes a parent can make that will help a child overcome the challenge of bedwetting. These include:

  • Limiting how much a child drinks beginning in the evening or late afternoon.
  • Making sure that a child at least tries to urinate right before bedtime.
  • Encouraging children to urinate throughout the day and not to ignore the “call of nature”. This might involve a discrete talk with teachers so that they, too, can encourage regular bathroom use.
  • Serving your child a high-fiber diet with fresh fruits and vegetables and whole grains to avoid constipation, which can contribute to bedwetting.
  • Avoiding any drinks that contain caffeine, which can increase urine production.
  • Monitoring your child’s skin and reporting any rashes or irritation to the doctor to get treatment guidance.
  • Some parents also use complementary and alternative therapies such as acupuncture, hypnosis or homeopathic remedies to help with bedwetting; however, make sure that you inform your doctor if this is what you are planning!

In short, although bedwetting can be very embarrassing for a child or impact their social opportunities, it is rarely dangerous (unless, again, it indicates an underlying condition which needs treatment).  Often, a child will outgrow this problem naturally as he or she gets older and develops a larger bladder and stronger muscles.  However, there are treatments and lifestyle changes that can help your child overcome this problem – and have a good (and dry) night’s sleep!