Bedwetting (nocturnal enuresis)

What is bedwetting?

Bedwetting (nocturnal enuresis) is when a child over 5 cannot hold urine during sleep at least once a month. It is one of the most common problems of childhood: it happens in about 15% of 5-year-olds, 10% of 7-year-olds and 5% of 10-year-olds. It is a little more common in boys.

Each year the wetting resolves on its own in about 15% of these children, but in some it can continue into the teenage years. It affects the child’s self-esteem, friendships and family life, so waiting for years and saying “it will pass on its own” is not always the right choice.

Types

• Primary: the child has never been dry at night for more than 6 months. This is the most common type.
• Secondary: it has started again after the child was dry for at least 6 months. It is sometimes linked to stress, infection, constipation or another cause.
• Monosymptomatic: only bedwetting, with no daytime symptoms.
• Non-monosymptomatic: there are daytime symptoms too: urgency, frequent peeing, daytime wetting. In this case the daytime problems are treated first.

Why does it happen?

Bedwetting is explained by a combination of three main mechanisms:

1. Making too much urine at night. The body releases the hormone vasopressin to make less urine at night. In some children this hormone does not rise enough at night.
2. A small bladder capacity at night or bladder overactivity at night.
3. Difficulty waking up. The child does not wake up to the signal of a full bladder.

Heredity plays a strong role: if one parent wet the bed as a child, the chance for the child is about 40%, and if both parents did, up to 70%.

Constipation, snoring and sleep apnea (enlarged adenoids), and attention deficit also make wetting worse.

How to prepare for the visit

The most useful source of information is the bladder diary: for 2 days, you record when and how much the child drinks, when and how much the child pees, whether there was wetting at night, and the weight of the diaper in the morning. You can print the diary here and fill it in.

Treatment

Basic advice

• Enough fluid during the day, mainly in the morning and at midday. Cut down 1–2 hours before bed.
• Regular toilet visits 5–7 times during the day, and always before bed.
• Avoid sweet, fizzy and caffeinated drinks and salty foods in the evening.
• Treat constipation if present.
• Do not punish the child. Praise the child for following the agreed habits (toilet before bed, the diary, taking part in treatment), and involve the child in the process.

Bedwetting alarm

A sensor placed in the underwear or on the mattress makes a sound at the first drop and wakes the child. Over time the child learns to wake up on their own with a full bladder. It is the most effective long-term treatment, but it requires patience and nighttime support from the family. Results usually show in 6–8 weeks.

Desmopressin

This is a medication that reduces urine production at night and is taken before bed. It works quickly and is especially helpful in children who make a lot of urine at night. Fluids should be restricted from 1 hour before the dose until morning. There is a chance of relapse when the medication is stopped, so it is reduced gradually.

Combined and other treatments

In children who do not respond to a single treatment, the alarm and desmopressin can be used together, or medications that relax the bladder can be added.

Online program

A 12-week online program has been developed for bedwetting, to be followed step by step at home: the diary, advice and explanations for parents are all in one place. You can learn about the program at bedwettingdoctor.com.