By Dr. Loretta Lanphier, ND, CN, HHP, CH

Wetting the bed can be very frustrating for both child and parent. However, most of the time children will out grow the condition, and parents should be reassured that it is a common and even somewhat normal occurrence in young children. As with most medical issues, there are various treatments available, some of which include drugs that can be quite hazardous. The good news is that there are several noninvasive therapies that are highly successful in most cases. Join me for a discussion of how bed-wetting occurs, how it can be stopped, and most importantly how it may be prevented in the first place.

What is Bed-Wetting?

Bed-wetting is generally described as the involuntary and usually unintentional discharge of urine while sleeping. It also goes by several other names, including enuresis, nocturnal enuresis, or nighttime incontinence. It is more widely defined as involuntary incontinence that may occur at night (nocturnal enuresis) or during the day (diurnal enuresis). Bed-wetting can be further classified as primary enuresis, which occurs in kids who have never learned bladder control, or secondary enuresis, which is found in children who have had a previous prolonged period of staying dry at night.

It is most common in youngsters under the age of 5 or 6, and is found more frequently in boys than in girls. How common of a problem is bed-wetting? On average, most children become toilet trained between the ages of two to four. Complete bladder control is a little harder to pin down, as it varies greatly between children. However, statistics tell us that approximately 40% of children will experience some degree of bed-wetting during their preschool years, with the percentage of boys being somewhat higher. After the age of five, the rate of occurrence drops to about 10% of children, and at age 10 to 5%. Less than 1% of bed-wetting occurs in individuals over the age of 10.

Enuresis is caused by a variety of suspected factors, but the exact causes may be difficult to pin down. We do know that this behavior has a clear tendency to run in families. It has been statistically proven that when a child has two parents who suffered from bed-wetting, there is an estimated 70-80% chance that he or she will struggle with it too. Studies have also been done that hint towards a genetic factor in bedwetting. It has been discovered that identical twins are more likely to both develop enuresis than are fraternal twins. Perhaps genes play a bigger role than family culture or other environmental factors. As we will discuss below, bed-wetting can be the result of both physical and psychological factors. It is thought that only a small minority of enuresis cases are the result of anatomical or physiological problems within the urinary or nervous systems of patients. The vast majority of enuresis cases are involuntary, but certain individuals with behavioral disorders may intentionally wet the bed or their clothing. This has been known to occur in kids with severe emotional problems or in children with a condition called Reactive Attachment Disorder (RAD).

It is sometimes difficult for parents or care givers to determine if a child is going through a normal growth phase that involves bed-wetting, or if a physical or psychological problem exists that is behind the behavior. Analyzing enuresis is not an exact science, but many researchers consider any bed-wetting under the age of six to be “normal,” especially if it occurs only once or month or less. In order for enuresis to be officially diagnosed, it must involve repeated episodes in a child aged five or older that happen at least twice per week for three consecutive months or more. Parents must take into consideration patterns and characteristics they observe in their own child and in their family history when considering whether he or she has a “bed-wetting problem” that necessitates outside intervention from a health care professional.

Potential Causes for Bed-Wetting

There are many possible reasons why a child may wet the bed. Some of the most common ones include:

  • Underdeveloped bladder: Some children simply do not have a large enough bladder yet to effectively hold all the urine they may produce at night. This cause of enuresis will correct itself in short time, when the bladder fully develops.
  • Immature urinary nerves: This issue is somewhat related to the underdeveloped bladder. It takes longer for some kids to develop the nerves involved in recognizing that the bladder is full. In that case, the nervous system is not able to awaken a child with the feeling that he or she has to “go.” This may be especially true for children that are deep sleepers.
  • Insufficient levels of ADH: This anti-diuretic hormone is designed to concentrate our urine while we sleep so that it contains less water and thus takes up less space. Many children have not yet developed the capacity to produce enough ADH to do the job.
  • Constipation: If a child suffers from chronic constipation, it can also affect his ability to hold urine at night. Make sure your youngsters eat a wholesome diet with plenty of fiber, get adequate exercise, and drink enough pure water as a hedge against constipation. (Drinking too much at the wrong times can aggravate bed-wetting—more on that in a moment).
  • Stress: Children who are suffering from undue stress can develop a bed-wetting problem or have a harder time conquering it. This stress may be caused by triggers such as divorce, death of a family member, a new sibling, or fear of wetting the bed (such as when sleeping away from home).
  • Diabetes: If unexpected secondary enuresis appears, it can be a sign of Type I diabetes. Accompanying signs might include excessive thirst, increased urine output, weight loss in spite of a good appetite, or unexplained fatigue.
  • Sleep apnea: This condition causes individuals to have their breathing interrupted during sleep. When it is found in children, it is often the result of inflamed tonsils or adenoids, and may cause bed-wetting. Other symptoms of sleep apnea might include daytime sleepiness, chronic snoring, and repeated sinus and ear infections or sore throats.
  • Other medical conditions: These may include urinary tract infections, epilepsy, sickle-cell anemia, or physical disabilities such as a spinal chord injury.
  • Allergies: In some instances, intolerance to certain foods can result in a bed-wetting problem. Some common culprits include chocolate, dairy products, or citrus fruits.

What Treatments Are Available for Bed-Wetting?

First a word of caution. Medications are often suggested by doctors to treat bed-wetting. There are two important reasons to avoid the use of drugs to treat enuresis in children. First of all, the drugs that are usually prescribed can be very dangerous. One common one is a synthetic hormone called DDAVP, which can and has triggered seizures in children. It is also very ineffective, only “working” in about 50% of cases. It also does not “cure” bed-wetting, as the behavior will return when the drug is stopped. Even without the seizures, it is a bad idea to put any form of artificial hormones in a child’s sensitive body.

Some pediatricians will also recommend the use of an antidepressant to alter a child’s sleep-wake patterns. Giving a child an antidepressant is a terrible idea. These drugs have very serious potential side effects, and I do not believe using any type of substance that alters brain chemistry is wise, especially in youngsters.

Besides the dangers of medication, they are just not necessary as there are several non-invasive therapies that are very safe and effective against enuresis. These include:

  • Behavioral modification: Making a few changes in the amount and timing of fluids can make a huge difference for your child. Many parents have found success by limiting drinks, especially late in the day, and by using a method called double-voiding. This involves having a child use the bathroom at the beginning of the bed time routine and then again immediately before lights out.
  • Another idea that is often useful actually involves drinking more fluids. This is appropriate when bladder development is delayed. Children are taught to increase the amount of fluid they drink, and to put off using the toilet as long as they can. This causes the muscles of the bladder to get stronger, and leads to greater control.
  • Kids may be rewarded for success, but should never be punished or embarrassed when they have an accident. Encourage them with loving support; never respond in anger. Children will respond much better if you work to help them solve the problem rather than condemn them for it.
  • Moisture alarms: This is a wonderful option that is very effective, although it may take a few weeks before a child is able to experience total dryness. A device that is available over the counter is used to sense dampness in a child’s bedding or clothing. If dampness is present, an alarm can alert an adult, or preferably the child himself so that he can recognize that he is voiding and immediately go to the bathroom. Kids usually experience increasing success, and it is a great tool to build their self-confidence, itself a very effective technique against enuresis.

Other tips that may help include:

  • Involving your child appropriately in the issues involved. An example might be allowing older children to change bedding or rinse clothing after an episode. This can give them a sense of responsibility and help motivate them to solve the problem. Such activities should never be used as punishment.
  • Put them to bed earlier: This may sound like it would only worsen the problem, but if a child is getting enough quality sleep, he may be more able to have victory over bed-wetting and be stronger both physically and emotionally.

Parents should remember that the vast majority of bed-wetting cases will resolve themselves in due time as their children mature both in body and spirit. A good dose of patience will go a long ways towards defusing the situation and creating an atmosphere in the home that is much more conducive to peace, open communication, and dry beds to boot! Give your child a chance to succeed. It will help him to learn that he can successfully meet other challenges that he will face later in life.

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