Toilet training a child takes a lot of patience, time and understanding. Most children do not become fully toilet trained until they are between two and four years of age. Some will be able to stay dry during the day. Others may not be able to stay dry during the night until they are older.
Causes of Bed-Wetting
Nighttime bed-wetting, called enuresis, is normal and very common among preschoolers. It affects about 40% of three-year-olds. All of the causes of bed-wetting are not fully understood, but the following are the main reasons a child wets the bed:
- His bladder is not yet developed enough to hold urine for a full night.
- He is not yet able to recognize when his bladder is full, wake up and use the toilet.
Most school-age children who wet their beds have primary enuresis. This means they have never developed nighttime bladder control. Instead, they have had this condition since birth and often have a family history of the problem. Children who are older when they develop nighttime bladder control often have at least one parent who had the same problem. In most cases, these children become dry at about the same age that their parent(s) did.
My Child Has Been Dry and Is Now Starting to Wet the Bed at Night
Often a child who has been dry at night will suddenly start bed-wetting again. When it happens, it is usually due to stress in the child’s life. Such stress could be due to a big change such as a new baby in the home, moving or a divorce. Children who are being physically or sexually abused may also develop enuresis. If your child wets the bed after having been dry at night in the past, your doctor should do an evaluation. The bed-wetting may be a sign that stress or a disease is causing the problem.
What Are the Signs of a Problem?
Some parents fear that their child’s bed-wetting is due to a disease or other physical problem. Actually, only about 1% of bed-wetting cases are related to diseases or defects such as:
- Bladder or kidney infections
- Defects in the child’s urinary system
With any of these cases there will often be changes in how much and how often your child urinates during the day. Your child may also have discomfort while urinating. Tell your doctor if you see any of the following signs at any age:
- Unusual straining during urination, a very small narrow stream of urine or dribbling that is constant or happens just after urination
- Cloudy or pink urine, or bloodstains on underpants or nightclothes
- Daytime as well as nighttime wetting
- Burning during urination
What Will the Doctor Ask Me?
In trying to find the cause of your child’s bed-wetting, your doctor may ask you the following questions:
- Is there a family history of bed-wetting?
- How often does your child urinate, and at what times of the day?
- When does your child wet the bed? Is your child very active, upset or under unusual stress when it happens?
- Does your child tend to wet the bed after drinking carbonated beverages, caffeine, citrus juices or a lot of water?
- Is there anything unusual about how your child urinates or the way his urine looks?
- Does your child have a history of constipation or infrequent hard bowel movements?
- Does your child have a history of learning problems or ADD/ADHD?
- Does your child wet himself during the day, even the slightest amount?
- Was there any prior history of urethral instrumentation?
- Is your child on any medications?
What Tests Will Be Performed if the Doctor Suspects a Problem?
If your doctor suspects a problem, he/she may take a urine sample from your child to check for signs of infection or other problem. Your doctor may also order tests, such as ultrasound of the kidneys or bladder, if there are signs that wetting is due to more than just delayed development of bladder control. On occasion when a child wets day and night, then a voiding cystouretrogram is performed if it is deemed necessary.
Tips to Manage Bed-Wetting
Reassure your child that the symptoms of enuresis will pass as he/she gets older. Until that happens naturally, however, the following steps might help the situation:
- Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.
- Use a bed-wetting alarm device. If your child reaches the age of seven or eight and is still not able to stay dry during the night, an alarm device might help. When the device senses urine, it sets off an alarm so that the child can wake up to use the toilet. Use this device exactly as directed so that it will detect the wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep. These alarms are available at most pharmacies and cost about $50. Although they provide a 60% to 70% cure rate, children often relapse once they stop using them. Alarms tend to be most helpful when children are starting to have some bladder control on their own.
- Protect and change the bed. Until your child can stay dry during the night, put a rubber or plastic cover between the sheet and mattress. This protects the bed from getting wet and smelling like urine.
- Let your child help. Encourage your child to change the wet sheets and covers. This teaches responsibility. At the same time it can relieve your child of any embarrassment from having family members know every time he/she wets the bed. If others in the family do have similar chores, though, your child may see this as punishment. In that case, it is not recommended.
- Other treatments. Some doctors recommend bladder-stretching exercises. With these, your child gradually increases the time between daytime urinations so that the bladder can slowly stretch to hold more urine.
- Because bed-wetting is such a common problem, many mail-order treatment programs and devices advertise that they are the cure. Use caution: many of these products make false claims and promises and may be overly expensive. Your doctor is the best source for advice, and you should ask for it before your child starts any treatment program.
Do Medications Help?
When no other form of treatment works, your doctor may prescribe medication. The use of medications to treat bed-wetting is used once all other treatment modalities are exhausted. The type of medication that will be used varies on the child and the history of bed-wetting. In some cases bed-wetting may respond better to certain medications than to others. We are well aware that no parent wishes to have their child take medications if it can be avoided and we use them only as a last resort.
What to Do if Nothing Works
A small number of children who wet the bed do not respond to any treatment. Fortunately, as each year passes, bed-wetting will decrease as the child’s body matures. By the teen years almost all children will have outgrown the problem. Only 1 in 100 adults is troubled by persistent bed-wetting. Until your older child outgrows bed-wetting, he/she will need a lot of emotional support from the family. Support from a pediatrician or a mental health professional can also help.
How Parents Can Provide Support
It is important that parents give support and encouragement to children who wet the bed. They should be sensitive to the child’s feelings about bed-wetting. For instance, children may not want to spend the night at a friend’s house or go to a summer camp. They may be embarrassed or scared that their friends will find out they wet the bed. Make sure your child understands that bed-wetting is not his fault and that it will get better in time. Reward him for “dry” nights, but do not punish him for “wet” ones. Remember, your child does not have control over the problem and would like it to stop, too!
Do not pressure your child to develop nighttime bladder control before her body is ready to do so. As hard as your child might try, the bed-wetting is beyond her control, and she may only get frustrated or depressed because she cannot stop it. Set a no-teasing rule in your family. Do not let family members, especially siblings, tease a child who wets the bed. Explain to them that their brother/sister does not wet the bed on purpose. Do not make an issue of the bed-wetting every time it occurs. If your child has enuresis, discussing it with your pediatrician can help you understand it better. Your pediatrician can also reassure you that your child is normal and that he/she will eventually outgrow bed-wetting.
A website about bed-wetting designed for both parents and their children (www.drynight.com)