What is bed-wetting?

Bed-wetting may be caused by having a small or overactive bladder, constipation, or low amounts of a hormone called ADH. Sometimes, bed-wetting is caused by emotional or social problems or by having a pattern of sleeping very deeply.

It's important to remember that bed-wetting isn't your fault. It's a good idea to talk to your doctor about it. Your doctor may be able to help.

Treatments for bed-wetting include limiting the amount you drink in the evening. Some teens find a moisture alarm useful. When the alarm senses urine, it buzzes to wake you up. Medicine to help you stop wetting the bed may also be used.

Children may wet the bed several times during the night, and they may not wake up after wetting.

Children grow and develop at different rates, and bladder control is achieved at an individual pace. Bed-wetting that continues past the age that most children have nighttime bladder control will usually stop over time without treatment.

There are often no other symptoms besides wetting the bed. If a child cries or has pain when urinating or has strong urges to urinate, bed-wetting may be a symptom of another medical condition. Call the doctor if your child has any of these symptoms.

Most children gain bladder control over time without any treatment. Bed-wetting that continues past the age that most children have nighttime bladder control—typically at 5 or 6 years of age—also will usually stop over time without treatment. If not, home treatment may be all that's needed to help a child stop wetting the bed.

If home treatment doesn't work, if the child and parents need help, or if the bed-wetting may be caused by a medical problem, medical treatment may be helpful. With treatment, your child may wet the bed less often or may wake up to use the toilet more often.

Treatment for bed-wetting is based on the:

Child's age.

Some treatments work better than others for children of a specific age group.

Child's and parents' attitudes about the bed-wetting.

If gaining bladder control is seen as a normal process, it's usually easier for the child to stop wetting the bed.

Home situation.

If the child shares a bedroom with other children, certain techniques to arouse the child, such as some moisture alarms, may not be practical.

Treatment may help if bed-wetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with peers.

Treatment options

Treatment for bed-wetting usually isn't a cure. The goal is to reduce the number of times the child wets the bed and to manage the wetting until it goes away on its own. Treatment may include:

Motivational therapy.

With this method, parents encourage and reinforce a child's sense of control over bed-wetting.

Moisture alarms.

These alarms detect wetness in the child's underpants during sleep. They sound an alarm to wake the child.

Desmopressin and tricyclic antidepressants.

These medicines increase the amount of urine that the bladder can hold or decrease the amount of urine released by the kidneys.

Other Treatment

You may hear of other ways to help children who wet the bed. But not all of these treatments have good evidence that they help. Talk to your doctor before you spend time and money on these other treatments. Ask about the risks and benefits. Examples include:

• Acupuncture.
• Bladder-stretching exercises that teach the child to hold urine for longer periods of time.
• Dry-bed training, which consists of following a strict schedule for waking the child up at night until he or she learns to wake up alone when needed.
• Hypnosis.
• Waking your child and taking him or her to the toilet a few times each night, or having your older child wake himself or herself a few times each night to use the toilet.

It's not a good idea to have your child wear diapers or pull-ups at night on a regular basis. Using diapers can get in the way of proven treatments (such as motivational therapy and moisture alarms) that require a child to get up at night.

Counseling (psychotherapy) may be helpful for the child who has secondary enuresis or for bed-wetting that is caused by emotional stress. Psychotherapy involves talking with a trained counselor. The counselor helps the child identify and deal with the stress that may be causing the bed-wettings. The goal is to reduce or help manage the stress or to prevent stress from occurring.

Some children who finish a treatment and have dry nights for a while will start to wet the bed again. Repeating treatment, especially with a moisture alarm, usually helps bring back dry nights.

Treatment may be helpful if bed-wetting seems to be affecting your child's self-esteem or affecting how your child is doing with schoolwork or getting along with peers.

Treatment by age

The best solution may be a combination of treatments. Below are some suggestions for treatment options according to the age of your child.

Ages 5 to 8.

Help your child understand that wetting the bed is a normal part of growing up. Encouragement and praise may be all that is needed to help your child wake up before wetting. Praise and reward your child for the steps he or she takes to have dry nights. And have your child take an active role in cleaning up after wetting.

Ages 8 to 11.

If your child still wets the bed, a moisture alarm may help. Also, a medicine such as desmopressin can be helpful for occasional overnight events such as camp or sleepovers.

Ages 12 and older.

There can be major emotional effects if a child still wets the bed at this age, so treatment can be more aggressive. If consistent use of moisture alarms doesn't work, the doctor may suggest medicine, counseling, or both.

Moisture alarms are the most successful single treatment for bed-wetting. They work best for older children who can hear the alarm and wake themselves. If attempts to use a reward system (motivational therapy), drink most fluids in the morning and afternoon, and use the toilet right before going to bed aren't helping, then an alarm may be a good choice for your child. Moisture alarms may be used with other treatments. The alarms aren't meant for children who wet the bed only once or twice a week.

Moisture alarms for bed-wetting are worn on the body and make a sound when urine first touches the child's underclothing. The child is encouraged to try to "beat the buzzer." When the alarm sounds, the child:

1. Gets out of bed and turns off the alarm.
2. Goes to the bathroom to finish urinating (even if the child no longer feels any need to).
3. Changes clothing and wipes down or replaces the moisture sensor.
4. Changes the linens or puts a towel on any wet spot.
5. Resets the alarm and goes back to sleep.

At first, parents may need to help the child with all of the above steps. Children younger than 10 may not hear the alarm, but the treatment still works if parents hear it and wake the child. Also, the parent or child may keep a chart or calendar of dry, wet, and wet-spot nights to encourage the child. The child's doctor will want updates on how this method is working.

A child is less likely to return to bed-wetting after using a moisture alarm if:

• Treatment is continued until the child has been dry every night in a row for at least 2 weeks. It can take up to 4 months to see results.
• The child drinks extra liquids during the day toward the end of treatment, to stretch the bladder.

Moisture alarms are inexpensive, safe, and fairly simple to use. But the child and the parents need to be trained on how to use the alarm.

Any child older than age 5 or 6 who keeps wetting the bed may need to be checked by a doctor. A medical history and physical exam are used to diagnose bed-wetting. A urinalysis may also be done.

Medicines that either increase the amount of urine that the bladder can hold (bladder capacity) or decrease the amount of urine released by the kidneys may be used to treat bed-wetting. These prescription medicines may be used to control bed-wetting for a little while. They don't completely stop it.

• Medicines work well to control accidental wetting for short periods of time, such as when children are on overnight trips or at camp.
• Your doctor may suggest them for bed-wetting that is related to a stressful event, such as divorce or the birth of a sibling.
• Sometimes medicines are used along with other treatments or for children who have not been able to control bed-wetting with other treatments. Medicines can help to encourage and motivate a child who is having trouble with other treatments by letting the child feel what it is like to have dry nights.

• Limit the amount of liquid you drink after dinner. Avoid sugary drinks and caffeine (such as tea, cola, chocolate) after dinner.
• Remember to use the bathroom just before going to bed.
• If you try a moisture alarm, learn how to use it properly.
• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.

If your child wets the bed, don't blame yourself or the other parent. Don't punish, blame, or embarrass your child. Your child is neither consciously nor unconsciously choosing to wet the bed. Give your child understanding, encouragement, love, and positive support.

• Be patient about changing the bed linens. Don't act offended by the smell of urine.
• Do not wake the child up at different times during the night to go to the bathroom unless it is part of a systematic treatment that the child has agreed to.
• Do not make the child feel bad. Shaming or punishing the child may make the problem worse.
• If you think your child may be feeling emotional stress, talk with a health professional about whether counseling may be helpful.

Bed-wetting is accidental urination during sleep. Children younger than 4 often wet their beds or clothes because they can't yet control their bladders. Bed-wetting can also start after a child has been dry at night for a long time.

Children don't wet the bed on purpose. Most likely, a child wets the bed for one or more reasons, such as having a small or overactive bladder, constipation, having too little of a certain hormone, or having emotional or social problems. An infection may also cause bed-wetting.