As they grow and mature, young children gradually gain mastery over bodily processes, including bladder control. Many children stay dry at night by age three or four, about six months after they have mastered daytime bladder control. But in about 15 percent of children, bed-wetting persists past the age of five (and acquires a medical name, enuresis).
Bedwetting may occur occasionally, or almost every night, and is more common in boys than girls. Many such children continue to have the problem for several years, though virtually all cases resolve by adolescence. It’s also not uncommon for children who previously had no trouble to have periodic lapses, particularly during times of stress.
Symptoms of Bed-Wetting
Involuntary loss of nighttime bladder control that persists beyond the age of five or six years
What Causes Bedwetting?
Less than 10 percent of the time, underlying medical problems are the cause. These can be easily identified by a physician and include an unusually small bladder, diabetes mellitus, kidney problems, epilepsy, sickle cell anemia, urinary tract infections, or developmental disorders like autism or mental retardation. If a child who is toilet trained is also having trouble staying dry during the day, it’s a good indication that the bed-wetting has a physical cause.
A genetic component appears to be included as well: the disorder often runs in families. Some studies suggest that bed-wetting may be linked to a deficiency in a naturally occurring substance called antidiuretic hormone, or vasopressin, which helps regulate the amount of urine produced.
Emotional factors (for example, acting out by the child) were once thought to be an important contributing factor. Although the stress of a move or a new sibling can cause periodic lapses in nighttime bladder control, persistent bed-wetting is rarely psychological in origin. Other factors such as sleeping disorders and taking diuretics (e.g., dark chocolate, caffeine and alcohol) may cause bedwetting.
What If You Do Nothing?
Most children outgrow the problem without any adverse consequences. The best thing to do is to be patient and supportive. Anger or disgust from parents or taunting by siblings can lead to shame and anxiety in a child, leading to more serious psychological problems.
Home Remedies for Bedwetting
- Maintain a supportive environment. A child will be frustrated and embarrassed by bed-wetting. Parents, too, will have their patience tried. Stay calm, and reassure your child (and yourself ) that bed-wetting is a condition that can, and will, be overcome. Let the child know that others (particularly if they are family members) have had the problem but outgrew it.
- Praise your child for dry nights; a calendar with gold stars or other rewards may help. Don’t become angry or blame your child for wetting the bed, and explain the importance of a sympathetic and encouraging home environment to other family members.
- Watch your child’s fluid intake at night. Get him or her to drink plenty of fluids in the morning or the afternoon to stretch the bladder and increase its capacity. Your child can drink fluids at night as well, but not in excess, and should avoid beverages that contain caffeine.
- Encourage bladder control practice. Have your child hold his or her urine for increasingly longer periods during the day—up to 10 to 15 extra minutes. This may help improve bladder control.
- Encourage urination before bedtime. Get your child in the habit of emptying the bladder as much as possible before going to bed. Once in bed, try positive imaging: have the child imagine waking up in the morning with clean, dry sheets.
- Consider wake-up breaks. Some experts suggest setting the alarm for several hours after bedtime and encouraging the child to get up and urinate at that time—though others say this needlessly disrupts the child’s natural sleep cycles. Special bed-wetting alarms that attach to the underwear and that are set off by the first hint of moisture are also available. You can discuss these options with your doctor. With time, your child will learn to recognize a full bladder and get up on his or her own.
- Protect your child’s bedding. To help minimize stress, make cleanup as easy as possible. Use two sets of sheets, with a rubber pad between them, and a plastic cover over the mattress. Children may wear an extra thick pair, or two pairs, of underwear, to help absorb urine. Don’t use diapers on children older than four; it will only humiliate them.
- Work in partnership with your child. Have your child assist with tasks: laundering the sheets, making up the bed, putting out a fresh pair of pajamas and a towel before retiring. The job should be fun and not punitive. Involving your child may increase his or her sense of control and help to resolve the problem.
- Give your child herbal tea, at least one hour before going to bed. Herbal teas such as lycopodium, ursi, causticum, oak bark, bearberry, pulstilla and wormwood are effective remedies for bed-wetting.
No specific measures can prevent persistent bedwetting. Some experts believe that toilet training at too early an age and at too rapid a pace can be stressful for a child and may cause psychological conflicts that contribute to the problem. Recognize bed-wetting as a normal stage of child development—one that, like walking and talking, comes at different times for different children.
Beyond Home Remedies: When To Call Your Doctor
If bed-wetting is accompanied by fever, abdominal pain, or blood in the urine, or by urinary pain, burning, or dribbling, it may be a sign of a urinary tract infection or some other physical problem; contact your doctor immediately. Also seek medical guidance if bed-wetting persists past age five or six and your child is unduly upset about it, or if bed-wetting newly develops in an otherwise healthy older child and persists for more than a month.
What Your Doctor Will Do
Your pediatrician will ask for a detailed history of the child’s medical condition, take a urine sample, and do a thorough physical examination, including careful inspection of the genital area to look for any physical causes for the problem. X-rays are sometimes also needed. Very small doses of the antidepressant medications imipramine or amitriptyline, which may help curb bed-wetting through an unknown mechanism, are sometimes prescribed. Another medication your doctor may recommend is desmopressin (DDAVP), a vasopressin-like hormone drug that reduces urine output during the night. If underlying psychological issues are suspected, counseling may be recommended.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media