Causes and Helpful Tips for Enuresis (Bedwetting)

What is enuresis?

Enuresis, also called nocturnal enuresis, is the medical term for bedwetting or urinating during sleep. Bedwetting is usually part of a child’s development. It is fairly common among children and is slightly more common in boys.

Most children outgrow bedwetting without any treatment or intervention. However, if enuresis is still experienced by children after 5 years old, treatment may be considered. Medications are not usually used for bedwetting unless children reach the age of seven. 

Causes of Enuresis

It is important to note that enuresis is not a behavioral or a mental problem. Bedwetting does not simply happen because children do not want to get up and pee in the bathroom. For this reason, children should not be punished or blamed when they wet their bed during sleep.

Although the cause of enuresis is not always obvious, there different medical conditions that can cause it. Certain tests may be performed if the doctor suspects that your child has any of the following conditions:

• Diabetes
• Constipation
• Spinal cord problem or disorder
• Urinary tract infection (UTI)
• Urethral valve problem
• Ureter problem

Stressful situations at school or home may also cause bedwetting in children. 

Other causes of enuresis may include:

• Deep Sleep: According to studies, children who frequently wet their bed are deep sleepers. They are often difficult to wake up and usually have trouble waking to an alarm clock.

• Low Vasopressin Production: Vasopressin is an antidiuretic hormone (ADH). If a person does not have enough ADH, the kidneys may excessively excrete water, which causes frequent urination.      

• Genetic Susceptibility or Predisposition: Bedwetting tends to run in families. It means that when you pee during sleep, there is a good chance that some members of your family or close relatives have also experienced bedwetting when they were kids. 

When do most children outgrow bedwetting?

Most children learn bladder control on their own and at different ages. By the age of 5, around 15 percent of children wet their bed. When children reach the age of 8, approximately 6-8 percent wet their bed, and around 2 percent of children may still experience bedwetting at the age of 15. 

Tips to Help Your Child

The following are some tips that can help your child cope with bedwetting:

• Limit your child’s fluid intake before bedtime
• Avoid giving your child drinks that contain caffeine, such as sodas.
• Train your child to use the bathroom at regular intervals during the daytime.
• Create a bedtime routine by letting your child pee before starting the bedtime routine and right before going to sleep.
• Whenever your child wets his or her bed, ask your child to change the sheets.
• Create a reward system for your child’s behavior, such as changing the sheets after wetting the bed, having a dry night, or using an alarm clock to wake up and urinate.
• Let your child practice bladder training by holding his or her urine for a longer time at daytime to help stretch the urinary bladder and hold more urine at nighttime. 

A child who wets his or her bed may feel embarrassed and guilty. These feelings may also lead to behavioral problems. Although it is important not to blame or make your child feel guilty, it is also important for your child to take responsibility for wetting his or her bed. Let your child become involved in doing the laundry to help clean up the mess.

Also, make sure that your child understands that bedwetting is not his or her fault. Instead of punishing your child for bedwetting, explain some of its potential causes and the things your child can do to help him or her cope with it. If you experienced bedwetting as a child, try sharing your experiences with your child. Always remember that punishing or blaming your child for bedwetting will only make matters worse and not solve the problem.  

You can also gently remind your child that he or she can use the bathroom when peeing at night. You can use nightlights to help your child find his or her way to the bathroom. For easier cleanup, make your child’s mattress waterproof by using waterproof mattress pads and underpads, waterproof duvet cover, or waterproof top sheets. Lastly, do not forget to praise your child whenever he or she tries to prevent bedwetting and for cleaning up when accidents occur. 

Treatment

Treatment for enuresis initially involves a practical approach, which includes educating the child and family members on proper dietary and fluid intake. Products that contain caffeine should be eliminated in the diet. Encourage your child to pee before going to bed and right after waking up in the morning.

Medications

Desmopressin and imipramine are two approved medications for enuresis. Imipramine’s exact action is still not completely understood. However, this medication has shown effectiveness in around 50 percent of children with enuresis.

Desmopressin is a synthetic form of the antidiuretic hormone (ADH). It also has a similar mechanism of action of ADH. This medication is effective when it comes to improving enuresis in approximately 60 percent of children. It comes in both pill and nasal spray forms. However, when this medication is used for a longer period of time, expense can become a problem due to its high cost. 

Behavior Modification

Approximately 70 percent of children have effectively improved enuresis through behavior modification, particularly with the use of an enuretic alarm. This alarm device has sensors that are sensitive to moisture. 

Children wake with the alarm and may pee in the bathroom before wetting their bed. Most children are assisted by their parents at first since bedwetters can sleep very deeply and have trouble waking up all by themselves.

This type of behavioral therapy has been known to be quite successful. This alarm device conditions the child to wake up when it is time to pee.

The alarm device is usually attached to a child’s underwear or pajamas and may be placed near the waist or shoulder. There are also wireless alarm units that can be placed on the counter. The alarm is triggered when the sensors become moist. Some alarms have a vibrating option, which enables the device to shake when moisture is detected. The alarm can help wake the child to get up and go to the bathroom to pee and finishing urinating. 

References

Bed-wetting: Tips to Help Your Child. (2014). The American Academy of Family Physicians. https://www.aafp.org/afp/2014/1015/p560-s1.pdf

What Is Nocturnal Enuresis (Bedwetting)? Urology Care Foundation. (n.d.). http://www.urologyhealth.org/urologic-conditions/nocturnal-enuresis-(bedwetting)

Bayne, A., & Skoog, S. (2014). Nocturnal Enuresis: An Approach to Assessment and Treatment. Pediatrics in Review, 35(8), 327-335. doi:10.1542/pir.35-8-327