Understanding Bedwetting (Nocturnal Enuresis)

Consistent bedwetting can be frustrating for both the child and the parents. Children often feel disappointed and guilty, while parents get exhausted from the bed hopping, laundry and middle-of-the-night wake-ups.

Bedwetting, also called nocturnal enuresis, is fairly common, with around 20 percent of children having some problems with bedwetting at age 5, and up to 10 percent still experiencing issues at age 7. Nocturnal enuresis is two to three times more common in boys than girls, and often runs in families.

There are two types of enuresis:

• Primary nocturnal enuresis is when children have not achieved dry nights since potty training.
• Secondary nocturnal enuresis is when children have been dry at nights consistently for six months, but then experience a regression.

Pediatricians can diagnose either of these types of enuresis with a parent/child interview, a physical examination and a urinalysis, to check for infection, unwanted blood or other elements in the urine. If further testing is needed, the doctor may perform a blood test or a bladder scan on the child.

Why Bedwetting Occurs

Bedwetting is typically a result of a child being a really deep sleeper as well as someone who holds their urine for a long time. When children hold their urine for too long, they train their bladders to not signal a bathroom break is needed until it is close to being an emergency. Combine a delayed signal from the bladder with a child in a deep sleep and bedwetting will occur.

If a child is experiencing bedwetting, a pediatrician will typically recommend the following as first steps:

• • No fluids before bedtime – at least an hour before bedtime
  • Cut down on any and all caffeine, which serves as a diuretic, which causes a more frequent passing of urine
  • Make sure the child urinates right before bed
  • Keep bedtime routine very consistent

Daytime Habits Lead to Nighttime Dryness

The best way to prevent nocturnal bedwetting is to concentrate on potty habits during the day.

It is important to take control of the child’s daytime bathroom habits. Doing so will begin to re-train the child’s bladder/brain connection.

A few suggestions: 

• • Choose three to four months when this plan can be implemented.

• • Set a schedule and follow it. Have the child go to the bathroom, even if they don’t feel the urge at that time, at specific intervals and keep that schedule consistent.

• • Begin with an interval of every 1.5 hours and set an alarm so both child and parent know when they need to be going.

• • For this plan to work, parents and children both need to be committed. Agree with the child on a date when the schedule will begin, and make the commitment together. The schedule must be followed.

• • The child – both boys and girls – should sit down when using the restroom. This helps them relax and will also help make bowel movements more consistent.

• • Use the “Wobble Watch,” or a similar product, which has a reminder timer and physical stimulus to remind the child when it is time to go.

• • Make sure the child wears underwear and not Pull-ups or a different diaper-like product. It is important for the child to feel the sensation of being wet, and Pull-ups and diapers wick the moisture away from the skin.

• • The American Academy of Pediatrics recommends nighttime alarms as the number one tool in fighting bedwetting. Use an alarm inside the child’s underwear, which activates when moisture is present. Dr. James recommends the Wet Stop 3 Plus.

• • Parents are encouraged to perform a few drills with the alarm during the day so the child knows what to expect and what to do.

• • Parents should also set-off the underwear alarm one hour after the child has fallen asleep. This helps program the child’s brain to be more aware of the alarm. The alarm works to change the child’s sleep patterns, as most bedwetting occurs around the same time each night. The alarm helps the child get used to being at a lighter stage of sleep at the point when he or she typically wets the bed.

• • Correcting bedwetting should be a positive experience, as much as possible. Parents should not punish the child for accidents, as punishment is counterproductive. Instead, offer rewards for cooperating and completing tasks.

Medication

For children who continually struggle with bedwetting, a pediatrician might recommend a medication called Desmopressin, also referred to as DDAVP, which mimics natural hormones and helps control water in the body.

This medication can make a child less thirsty and feel the need to urinate less. DDAVP has been proven to cut down on nighttime accidents, but doctors have found that the accidents typically return once the child stops taking the medicine. DDAVP can still be helpful, however, as one of the biggest struggles with bedwetting can be social situations, like sleepovers or vacations.

The medication comes in a pill form, so children have to be able to swallow pills, and DDAVP is only approved for use in children over the age of 6. There are also some significant fluid restrictions with the medicine, as no liquid can be ingested an hour before taking it or for eight hours after.

Further Treatment

If, after completing the steps above, a child is still struggling with bedwetting, it could be a larger issue.

Parents should visit with the child’s pediatrician if a child was not having issues for months – or even years – and all of a sudden begins experiencing bedwetting again. This could be signs of a urinary tract infection or diabetes. The child may also be experiencing abuse/trauma, change in the family or another possible psychological issue.

The most important part of any plan to stop bedwetting is for the parents to create a positive environment for the child. Parents are encouraged to stay patient and understanding. Fighting bedwetting is fighting a sleep pattern, which can be slow to overcome.