Strategies for Combating Bedwetting

Is your child one of the approximate 5 to 7 million American kids that wet the bed some (or most) nights? If so, you have likely tried everything you can think of to correct the condition. Though common, bedwetting is an issue that families often struggle to overcome.

By the time they reach five years of age, 75 to 85 percent of children remain dry through the night. With each passing year, another 15 percent of the remaining kids will cease to wet the bed. Even when it subsides, bedwetting (medically known as nocturnal enuresis) can sometimes return without warning.

In a recent study of more than 1,200 kids who still wet the bed at 7½ years of age, researchers looked into the effectiveness of some of the most prevalent parental strategies in combatting bedwetting. They concluded that some techniques, like waking the child to urinate during the night, either do nothing or can cause the problem to persist or return. The “wait-and-see” approach of assuming the child will outgrow bedwetting is also problematic, they say, because it leaves children at risk of undiagnosed conditions.

Why do some kids wet the bed?

The idea that bedwetting (enuresis) is an act of rebellion is antiquated. Physicians now consider it to be a set of conditions, each with different causes and risk factors. There are two categories of bedwetting. Primary enuresis is when a child continues to wet the bed after potty training is complete. Secondary enuresis is when a child who has had at least six months of consecutive dry nights suddenly begins wetting the bed. Of the two, secondary enuresis gives more cause for concern, and we’ll discuss it shortly. First, let’s consider some common causes of primary enuresis.

Some Causes of Primary Enuresis
  1. An undersized bladder: The bladder has not yet grown large enough to contain the amount of urine the child produces during the night. This condition normally resolves itself over time.
  2. Hormone irregularity: The body uses anti-diuretic hormones to slow urine production at night. In some children, the production of this hormone is delayed. There are prescription drugs available to correct this issue, at least for the short term.
  3. Sleep disorder: When children are particularly deep sleepers, the urge to urinate may not wake them. When accompanied by repeated ear infections, sinus infections, snoring, or daytime drowsiness, bedwetting may be a sign of sleep apnea.
  4. Slow-maturing nerves: The nerves that control bladder function mature at different rates for different individuals. For affected kids, a full bladder may not trigger enough of an urge to urinate to wake the child until these nerves have time to mature.
  5. Neurological or urinary tract issues: Though uncommon, defects in the structure of either of these systems may cause bedwetting.
As you can see, defiance is certainly not the cause of bedwetting. Wetting the bed is embarrassing to children, and it becomes more so as they age. It causes stress that most of them would gladly live without, and yelling at them about it -- as if it was their choice to do so -- only makes matters worse. It is important that parents and caregivers be patient and understand that children almost always overcome primary enuresis. Speak to your local Cape Coral pediatrician about your concerns. Your doctor can help you decide on treatment strategies, and may suggest any pharmacological treatments that may be applicable.

Children also benefit from developing an understanding that their condition is normal, and that plenty of other kids also struggle with it. Having a parent who wet the bed is also increases the risk for enuresis in children, and perhaps you dealt with bedwetting yourself. Your child will likely feel reassured if you explain that you had the same issues as well. Tell them how it made you feel; it may help them understand that they are not alone. [Link: ]

Some Causes of Secondary Enuresis
  1. Constipation: When bedwetting makes a sudden appearance, one possible cause is constipation. The muscles that control the bowels are the same ones that control the bladder. When they stop functioning properly, either condition can arise.
  2. New stresses: Children are sensitive to life changes that are beyond their control. Beginning school or a new grade, welcoming a new sibling, and parental arguments can all trigger bedwetting.
  3. Diabetes onset: Bedwetting alone does not signal an underlying condition like diabetes. But when it occurs in conjunction with other symptoms — dry mouth, thirst, fatigue, unexplained weight loss, etc. — it is certainly cause for concern and a reason to contact your local Cape Coral or Fort Myers pediatrician.
  4. Urinary tract infection (UTI): A common cause of bedwetting, UTIs are treatable with antibiotics. Other symptoms include red- or pink-colored urine, and frequent or painful urination. Accidents may also occur during the day.
  5. When a child that has been dry for more than six months suddenly begins wetting the bed, consult your pediatrician here at MacKoul Pediatrics at once. Not every cause of secondary enuresis is serious, but your doctor can perform tests to eliminate certain medical conditions from consideration. Physiological conditions and their accompanying symptoms, such as bedwetting, can worsen if left untreated.

So What Helps And What Doesn't?

Parents often get the advice that, while parental interventions are only rarely and moderately effective at eliminating bedwetting, they should still try them. Doing something is better than doing nothing, after all -- or so the story goes. However, new evidence suggests that sometimes our help, no matter how well-intentioned, may actually make a bedwetting condition worse.
  1. Waking and lifting: Waking a child to urinate during the night is a longstanding parental strategy. Lifting is a more delicate operation, involving keeping children asleep as they are carried to the bathroom. The above-cited study revealed no benefit to either strategy, and it even suggests that lifting may actually encourage bedwetting because it reinforces emptying the bladder while sleeping.
  2. Star charts: This strategy involves keeping a chart and affixing a sticker to it for each night a child does not wet the bed. After a predetermined amount of dry nights, the child earns some type of prize or reward. The new study revealed that this method is only slightly better than a placebo at bringing bedwetting to an early end, and that it may lead to further frustration as it rewards children for behaviors over which they have no control.
  3. Timing of fluid intake: As bedwetting is the natural result of a full bladder, it only makes sense to restrict drinking before bedtime. In theory, this practice gives your child ample time to empty the bladder before going to bed and keeps the body from producing too much urine during sleep. However, the enuresis study authors suggest that this intervention may lead to ill effects like dehydration. Parents should employ this strategy carefully, if at all.
  4. Adjusting their diet: Diet adjustment strategies include reducing the child’s daily salt intake and eliminating caffeine, which is a diuretic. While neither of these diet adjustments has been shown to cure bedwetting, they can reduce its frequency. Parents should take care to ensure their children eat a healthy diet.
  5. Bedwetting alarms: These battery-powered alarms are designed to go off when urine contacts them. They may sound an alarm when triggered, or they may be set to a vibration mode that prevents them from waking other people in the home. The authors of the study on enuresis cite the Royal College of Physicians recommendation that alarms be a first-line strategy for combatting bedwetting, as it is one of the only interventions that seems to have any effect.  Bedwetting alarms are available online.
  6. Anti-diuretics: Desmopressin is the synthetic form of the anti-diuretic hormone our bodies produce naturally. It is an anti-diuretic commonly prescribed to children 7 years old or older. The new enuresis study’s authors suggest that desmopressin is often an effective short-term treatment for bedwetting, especially when used in conjunction with bedwetting alarms. Your pediatrician at MacKoul can help you decide if desmopressin is a suitable treatment for your child.
Some Things To Remember

Not long ago, parents often received the advice that they handle bedwetting on their own. Because of the frustration it can cause both parent and child though, some parents resorted to scolding or punishing children for wetting the bed. We now know that there is almost always an underlying cause for bedwetting, even if it is difficult or impossible to know what it is with certainty. When their parents treat them with understanding and patience, children’s bedwetting issues often go away on their own.

However, you should make your child’s pediatrician aware of your concerns about frequent bedwetting as soon as possible. Your doctor here at MacKoul will know if there is cause for concern, and whether to pursue treatments other than parenting strategies. Normally, there is no reason to worry, but an early diagnosis of an underlying illness will always give your child the best chance at a speedy recovery. If your child is showing signs of frequent bedwetting, please give us a call at (239) 573-2001 to schedule and appointment with your child's doctor.

If you have concerns, please don't hesitate to give us a call to schedule an appointment. MacKoul Pediatrics of Cape Coral is here to help your child be as healthy and as happy as possible, and we are here to help answer any questions you might have. Just give us a call at (239) 573-2001.