Bedwetting: What Can You Do?

Also known as nocturnal enuresis, bedwetting is an event that occurs in most children during potty-training years—it’s estimated that about seven million children in the United States alone wet the bed on a regular basis. Before age 7, bedwetting is considered normal and a result of immaturity.

At a certain point, however, bedwetting may be an indicator of a more serious underlying medical condition.

Types of Bedwetting

There are two forms of bedwetting in children:

Primary bedwetting: The child has never had control over their urination at night
Secondary bedwetting: Less common, refers to bedwetting after a child has been dry during sleep for at least six months. Secondary bedwetting could be caused by psychological stress or by an underlying medical condition like constipation or a urinary tract infection

Risk Factors

There are no definite known causes of bedwetting, but there are several factors that may play a role, which you should pay close attention to if they’re present:

Gender: Bedwetting is twice as common in boys as in girls
Family history
ADHD: Bedwetting is more common in children with attention-deficit/hyperactivity disorder
Small bladder
Inability for the nerves in the body to recognize a full bladder and wake the child
Hormone imbalance: Lack of antidiuretic hormone to slow nighttime urine production
Stress
Urinary tract infection
Sleep apnea: Bedwetting can be a sign of obstructive sleep apnea
Diabetes: Bedwetting may be the first sign of diabetes in a child who is usually dry at night
Chronic constipation: The same muscles used in urination are also used in stool elimination, and these muscles can become dysfunctional with long-term constipation
Structural issues: In rare cases, issues with the urinary tract or nervous system may be causes of bedwetting.

Behavioral Treatment

In most cases, children outgrow bedwetting on their own. In other cases, treatments such as moisture alarms or medications might be used when more conservative methods fail. Commonly prescribed conservative behavioral methods for treating bedwetting include:

Establish a regular bedtime routine, including using the bathroom
Wake your child at night before they typically wet the bed, and take them to the bathroom
Develop a reward system for dry nights
Talk to your child about the advantages of potty training
Limit beverages in the evening, including last-minute requests for water
Moisture alarms: These alarms go off whenever the child’s pajamas or bed become wet during an accident. Over time, this system will teach the child to wake up before bedwetting occurs.

Other Changes

For many parents, making basic changes around the home can have a real effect on preventing bedwetting. These changes might include:

Limit evening drinking: Encourage your child to focus on drinking plenty of liquids in the morning and during the afternoon, so there isn’t as much thirst during the evenings.
Caffeine: Avoid foods and beverages with caffeine at any time of day, particularly the evening. Caffeine may stimulate the bladder.
Double voiding: Double voiding involves urinating at the start of the bedtime routine, then again just before sleep. Remind your child that it’s fine if they need to get up at night and use the toilet again, and use a small night-light in case this becomes necessary.
Regular toilet use: Encourage regular toilet use during the day and evening—every two hours or so, or enough to never feel urgent about urinating.
Treat constipation: Possibly with a stool softener recommended by your doctor.
Rashes: Prevent rashes caused by wet underpants by rinsing your child’s bottom and genital area each morning. Some parents find success covering the affected area with a protective moisture barrier ointment or cream at bedtime.

If your child is dealing with regular bedwetting issues that might be part of an underlying condition, your doctor can offer further recommendations for treatment and prevention.