Bedwetting (Enuresis)
Bedwetting is a common problem in up to 15% of kids 5 and older. Bedwetting is also called enuresis. Boys are twice as likely as girls to have trouble with bedwetting and it tends to run in families. It is more likely that children with ADHD, autism spectrum disorder, or intellectual disability will have trouble with nighttime dryness. Most of the time, bedwetting is not related to a medical or behavioral problem – it just takes some kids longer to start to recognize their bodies’ signals while they’re asleep. Of course it can be very frustrating to parents when their child has trouble staying dry overnight but it is important to remember that bedwetting is never a child’s or a parent’s fault, and punishments may make the problem worse.
If your child has never been consistently dry at night, this is referred to as primary enuresis.
Secondary enuresis is when a child who has been dry at night for a period of 6 months or longer starts wetting the bed again. This sometimes happens when a child goes through a stressful life event like family separation/divorce or the arrival of a new brother or sister. Most often the reason for recurrence of bedwetting is never known.
Bedwetting tends to get better on its own as kids get older. By the time children turn 10 years old, only 5% will still have trouble with bedwetting and at age 15, only 1-2% will continue to wet the bed. Although most bedwetting does stop on its own, many caregivers and children are motivated to try some form of treatment. Even occasional bed wetting can cause a child to have decreased self-esteem and can limit his or her ability to participate in activities like camps and sleepovers.
Bedwetting Treatments
Treatment for bedwetting is available, but the right choice for treatment depends on a number of factors, including your child’s age, his or her motivation to stay dry at night, and your own motivation to help him or her through the treatment.
Before starting treatment, it’s important to talk to your provider about other symptoms that could point to another medical problem as the reason for bedwetting. Your provider will ask you questions to help to make sure that problems like constipation, urinary tract infection, pinworm infection, diabetes, sleep apnea, and kidney or bladder disease are not the cause for your child’s bedwetting. He or she will also examine your child and perform an analysis of your child’s urine to look for any abnormalities.
The most effective treatment for long-term control of bedwetting is a bedwetting alarm system. The alarm has a sensor that is placed in your child’s underwear at night. When the sensor is activated by wetness/urine, it rings an alarm that is connected to the sensor with the goal of waking your child. The purpose of the alarm is not to stop the bedwetting in that instant – as you’ve probably noted, the bedwetting has to have already started for the alarm to go off – but over time, the alarm trains your child to wake up when he or she has a full bladder. Many parents who have children who wet the bed describe them as heavy sleepers. This may mean that the alarm wakes you, the caregiver, before it wakes your son or daughter. Although it is labor intensive for a caregiver, especially if your child urinates more than once overnight, bedwetting alarms are the best option for helping kids to stay dry overnight permanently. The process can take several months. They are more likely to be effective in children older than 7 years and in kids who are highly motivated to stay dry at night.
Another option for bedwetting treatment is a medication called desmopressin or DDAVP. This medication may be a good option for your child if he or she needs short-term control of bedwetting. It is given one hour before bedtime as a small tablet to swallow. Camps and sleepovers might be a motivation for your child to try this medication. It does not require nearly as much supervision and commitment from caregivers; however, it is usually only effective when a child is taking the medication and does not usually provide long-term control of bedwetting.
No matter what treatment option you choose for your child (including no treatment at all), there are a number of things to keep in mind:
- Bedwetting is not intentional and is neither your child’s nor your fault. Punishments only make the problem worse.
- Make sure your child empties his or her bladder right before bed.
- Avoid high-sugar and caffeinated drinks, especially in the evenings.
- Limiting the amount your child drinks in the evening is only sometimes effective – if it doesn’t work then there is no need to continue.
- Keep a diary of wet and dry night to help monitor if treatment is working – providing positive reinforcement for dry nights with a sticker chart can help your child stay motivated.
- Use a mattress protector and clothing/bedding that is easier to wash
- Help your child to clean him/herself well before getting dressed in the mornings.
- Avoid pull-ups or diapers if your child is actively trying treatment as this can interfere with motivation to get out of bed at night. If you are waiting to try an active treatment pull-ups or diapers may save your family time and stress with cleanups.
If bedwetting is a concern for you or your child, please contact our office to discuss further.
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