Nocturnal enuresis , defined as nighttime
bedwetting beyond age 5, affects many school-age children and even some teens. It's not a serious health problem, and children usually outgrow it. Still, bedwetting can be upsetting for children and parents.
It's important to work with your child's doctors to find possible causes and solutions. Here are some frequently asked questions.
How common is bedwetting in school-age children and teens?
Occasional "accidents" are common among children who are toilet trained. Around 20% of children have some problems with bedwetting at age 5, and up to 10% still do at age 7. By the late teens, the estimated rate of bedwetting is between 1% and 3% of children. Nocturnal enuresis is 2 to 3 times more common in boys than girls.
There are 2 types of nocturnal enuresis:
Primary enuresis: a child has never had bladder control at night and has always wet the bed.
Secondary enuresis: a child did have bladder control at night for a period of at least 6 months, but lost that control and now wets the bed again.
Primary enuresis is much more common. Secondary enuresis in older children or teens should be evaluated by a doctor. Bedwetting in this age group could be a sign of a urinary tract infection or other health problems, neurological issues (related to the brain), stress, or other issues.
What are some causes of bedwetting?
Although it is not completely understood why bedwetting occurs, it is thought to happen because of a delay in the development in at least one of the following three areas at nighttime:
Bladder: less space in the bladder at night
Kidney: more urine is made at night
Brain: unable to wake up during sleep
In babies and toddlers, links between the brain and the bladder have not fully formed; the bladder will just release urine whenever it feels full. As children get older, the connections between brain and bladder develop. This allows a child to control when the bladder empties. This control usually develops during the daytime first; it takes more time before it happens at night.
Other bedwetting risk factors:
Genetics. If one parent wet the bed after 5 years old, their children may have the same problem about 40% of the time. If both parents wet the bed as children, then each of their children would have about a 70% chance of having the same problem.
Stress. This is one of the most common reason for secondary enuresis. Children experience
stress when moving to a new home or school, experiencing a parental divorce or losing a parent or other people they love, or going through another major life event. This stress can cause bedwetting; treating the stress can stop the bedwetting.
Deep sleep. A deep sleep pattern can be part of normal adolescent development, as can a poor sleep schedule and too few hours of sleep. This is all common during
puberty and especially during a teen's high school years.
Obstructive sleep apnea/snoring. In rare cases, bedwetting happens because a child has
obstructive sleep apnea and
snores. Children with this condition have a partly blocked airway that can briefly stop their breathing when they sleep. This can change the chemical balance of the brain, which may trigger the bedwetting.
Constipation. The bladder and bowels sit very near each other in the body. A backed up bowel (constipation) can push on the bladder and cause the child to lose bladder control. Treating the
constipation is often the first step to treating the bedwetting in these cases. If your child is having pain or straining with bowel movements, this could be contributing to bedwetting.
kidney disease. This may be the case if a child has both daytime and nighttime bladder control problems and other urinary symptoms such as pain when peeing or the need to pee frequently.
Neurologic disease. Sometimes a spinal cord problem that develops with growth or that is present early in childhood can cause bedwetting. If your child has other symptoms like numbness, tingling, or pain in the legs, a spinal issue may be considered. However, this is a very rare cause of bedwetting.
medical conditions and/or medications. In rare cases, other medical conditions like
diabetes cause enuresis in children.
Some studies suggest that children with
attention-deficit/hyperactivity disorder are more likely to have enuresis, possibly because of differences in brain chemistry. Some medications can also increase the chances of bedwetting.
How is bedwetting evaluated?
Your child's doctor will first take a complete medical history and ask about any other urinary symptoms such as the urge to urinate a lot, the need to "run to the bathroom" a lot, or pain or burning while peeing. The doctor will also ask about sleep patterns, how often your child moves his or her bowels, and family health. The doctor will ask if either parent wet their bed at night as a child. Finally, the doctor may ask about stressful events in the child's life that could be adding to the problem.
Your child will also receive a complete physical exam including a simple urine test (urinalysis). This test shows signs of a disease or an infection. In most children with enuresis, the results of this test come back completely normal. X-rays are usually not needed.
Is there treatment for older children and teens who wet the bed?
Yes. However, treatment for bedwetting first depends on if it is caused by something like stress, which would need to be managed first. Overall, children who take an active part in their treatment have a better chance of decreasing or stopping the bedwetting.
Research shows that about half of children who properly use enuretic (bedwetting) alarms will stay dry at night after a few weeks. These alarms buzz or vibrate when a child's underwear gets wet. Over time, the brain is trained to associate the feeling of needing to pee with the alarm going off, and getting up and going to the bathroom. This therapy requires active participation by an adult to make sure the child fully wakes up and goes to the bathroom when the alarm goes off.
There are only two medications that have been approved for bedwetting—imipramine and desmopressin. It is important to note that bedwetting usually returns once medications are stopped, unless the child has "grown out of" nocturnal enuresis.
Imipramine works well in some children with nocturnal enuresis. There is a chance of overdose on this medicine, so it is important for parents to strictly control how and when they give the medicine. An
EKG is recommended before starting this medicine, although heart problems have not been reported with doses of imipramine used to treat bedwetting. Children with an abnormal EKG should not use this medicine.
Desmopressin (DDAVP) helps to reduce the amount of urine your body makes. It improves bedwetting in about 40% to 60% of children. DDAVP comes in both nasal spray and pill forms and is taken before bed. It is important to not drink any fluids after taking it to decrease the risk of electrolyte imbalance. An additional medication, oxybutynin, has been show to be helpful, especially in patients who do not respond to DDAVP alone and can be given in combination with it.
Will bedwetting stay with my child into adulthood?
Bedwetting almost always goes away on its own. Most children will grow out of it by the late teenage years or sooner. Secondary enuresis may go away when the cause is found. It is either treated, or it gets better on its own. If bedwetting has not stopped in the late teenage years, your child should be seen by a doctor.
Never wait to talk about bedwetting with your pediatrician to find a solution that works best for your child and your family.