Introduction

It's not that unusual for children and even teenagers to wet their bed sometimes, but people don't like talking about it. By about the age of five, most children either sleep through the night without wetting the bed, or wake up when they feel that their bladder is full. But this ability may only develop later on: More than 15% of all five-year-olds sometimes don't realize that their bladder is full until it's too late. By the time they have woken up, their bed is already wet.

Bedwetting can be very troubling for the family – especially if it happens often. It is considered to be “bedwetting” (medical term: nocturnal enuresis) if children over the age of five still wet the bed without there being a recognizable physical cause.

This problem usually goes away on its own over time. But until that happens, there are some things that parents can do to help their child and make it easier on themselves. Systems for waking the child provide the most effective help against bedwetting over the long run, but medication can also help in the short term. Each of these approaches has its pros and cons, and some require patience. It is important to encourage the child, and not scold or punish them.

Causes

The main reason why some children and teenagers wet the bed is because they don't wake up when their bladder is full. Instead, their bladder muscles relax, emptying the bladder while they are still asleep. Children do not wet the bed on purpose. They simply don't notice that their bladder is full – certain developmental processes need to occur in their body first. This takes longer in some children than in others. The developmental processes include the following:

• The child’s brain has to be able to detect and process nerve signals from the bladder so that they wake up when their bladder is full. They also have to develop control over their bladder muscles, which can take a while.
• Their body has to produce enough antidiuretic hormone (ADH) at night. This hormone, also called vasopressin, makes the kidneys produce less urine at night.
• Their bladder has to be big enough to store the urine that is produced at night.

Genetic factors also seem to play a role in how long it takes for children to stop wetting the bed. Comparisons between families have shown that more than half of children who wet their beds have other family members who were also affected by this problem.

Prevalence and outlook

Many children just wet their bed once or twice a month, while others do so several times a week. Bedwetting is more common among boys than it is among girls. The problem almost always goes away on its own over time. The following table shows how many children (still) wet the bed at different ages:

Sometimes children stay dry for more than six months and then suddenly start wetting the bed again. This is called “secondary enuresis.” It may be a sign that the child is under emotional stress – for instance, due to changes within the family, like the birth of a sibling, or because of family problems. Secondary enuresis might also have a physical cause such as a kidney or bladder infection, or diabetes.

Diagnosis

Doctors consider it to be "bedwetting" if a child is over five years old and wets the bed more than once a week for at least three months.

Bedwetting is only rarely a sign of a different medical problem. Doctors can rule out other possible causes. These include urinary tract infections, problems with the ureters (the tubes that carry urine from the kidneys to the bladder), early-stage diabetes and an overactive thyroid. Breathing pauses during sleep (sleep apnea) can also cause a brief loss of bladder control.

To rule out these kinds of problems, the doctor will talk with the parents and their child, and also carry out a physical examination. She or he will ask about signs of other possible illnesses – for instance, whether the child

• pees very rarely (less than three times a day) or very often (more than eight times a day),
• wets themselves or leaks a bit during the daytime too,
• has problems when peeing (e.g. getting the flow started or emptying their bladder in one go, without interruptions),
• has a weak stream,
• experiences pain when peeing, or
• has the feeling that their bladder isn't empty afterwards.

It can be helpful to keep a diary for several days to record what and how much the child eats and drinks, and when and how often he or she pees.

Rapid urine tests can be done to rule out things like urinary tract infections and diabetes. Other tests or examinations are usually only needed if there is reason to believe that the bedwetting is being caused by a medical problem.

Treatment

There's a lot of advice out there about what to do about bedwetting – but most of it isn't helpful. The most important thing is to ensure your child doesn't worry about it, and make it clear that it isn't his or her fault.

You can try to reduce the amount of fluids the child drinks in the last two hours before going to bed and during the night, and avoid caffeinated or sugary drinks such as cola in the evening. If a child has constipation, you can increase the amount of fiber in their diet.

Research has shown that electronic bedwetting alarms, such as alarms in underwear and special mats, are very helpful. These alarms detect wetness and then set off an alarm to wake the child up as soon as the first few drops leak out.

Medication only has a temporary effect and generally isn't recommended in children under the age of seven. It works quickly, but only for as long as it is taken. But it can help if the child needs to stay dry for a short period of time – for example, when sleeping away from home. Bedwetting medication usually has the drug desmopressin in it, which is similar to the hormone vasopressin that is produced in the body. Bedwetting alarms don't work in some children because they sleep too deeply. Treatment with desmopressin is an option here, too.

Everyday life

Many parents and children already feel better knowing that bedwetting isn't abnormal, and a lot of other families are affected too – and that the problem will very likely go away on its own.

Being prepared for nighttime accidents can make things easier in everyday life – for instance, by protecting the child’s mattress with waterproof rubber mats or covers, and having fresh sheets and bedding on hand. Then everyone can get back to sleep quickly. Some families use diapers or special absorbent pants for older children.

It is important to have the child shower in the morning and put on fresh clothes to avoid an unpleasant smell. This can help prevent negative reactions from friends or at school. To get rid of the urine odor in bed linen and clothes, things like baking soda or eucalyptus oil can be used in the wash.

Further information

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

• Caldwell PH, Deshpande AV, Von Gontard A. Management of nocturnal enuresis. BMJ 2013; 347: f6259. [PubMed: 24170156]
• Caldwell PH, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2013; (7): CD003637. [PubMed: 23881652]
• Deshpande AV, Caldwell PH, Sureshkumar P. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev 2012; (12): CD002238. [PMC free article: PMC7100585] [PubMed: 23235587]
• Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP), Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ). Enuresis und nicht-organische (funktionelle) Harninkontinenz bei Kindern und Jugendlichen (S2k-Leitlinie). AWMF-Registernr.: 028/026. December 02, 2015.
• Von Gontard A, Schaumburg H, Hollmann E, Eiberg H, Rittig S. The genetics of enuresis: a review. J Urol 2001; 166(6): 2438-2443. [PubMed: 11696807]

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