What is enuresis?
Nocturnal enuresis is the medical term for bed-wetting. All over the world, kids wet the bed. Bed-wetting is actually quite common. Even so, it can be very embarrassing for kids. They may feel very alone, like they can’t talk to other people about it. They may avoid certain social situations, like overnight camp and slumber parties. Other people may call them a “baby,” or blame them for being wet, even though they cannot help it. Bed-wetting can cause real problems like loss of self-esteem and other psychological distress for the child and the family.
How common is bed-wetting?
It’s very common. Every night five to seven million children in the United States wet their beds. More boys than girls do. About 15 percent of five-year-olds are wet at night. By age 12 about three percent of kids still wet the bed (mostly boys).
There are two types of nocturnal enuresis, with different kinds of causes:
- Primary nocturnal enuresis means the child has never had nighttime control; they have always wet at least two times a month. Most kids who wet the bed have primary enuresis. It is not caused by psychiatric or emotional problems. It can be caused by differences in bladder muscles, having a small bladder, making too much urine, and sleeping too deeply to wake up when the bladder is full. The most common cause it thought to be immaturity of the part of the brain that signals a full bladder and wakes you up. Bed-wetting can be inherited. Researchers have found a gene associated with it.
- Secondary nocturnal enuresis is less common and means that the child was completely dry at night for at least 6 months and then started wetting again. With secondary enuresis, the key is finding out what has changed in the child’s life. There may be a new stress like a divorce, a move, a new baby sibling, or a family death. The cause may be a new medical problem like a urinary tract infection (although UTIs are rare in children). Sometimes encopresis with constipation (when the intestine is full of poop, and taking up space from the bladder) can cause urine to leak out at night. A visit to your child’s doctor can help you uncover the cause.
Bed-wetting is normal for kids under age six. If your child is still wetting the bed at age six or seven, you should talk to your child’s doctor. When deciding whether to treat the bed-wetting, ask yourself whether it is causing problems for your child. If so, it’s probably a good idea to treat it. Keep in mind that 15 percent of kids who wet the bed will become dry each year, without any treatment.
- Call the National Kidney Foundation at 1-800-622-9010 for referral to a pediatrician in your area who has a special interest in treating bed-wetting.
Remember: Don’t punish your child for wetting the bed. It will not help! Your child cannot help it. There are many different treatments, and things you can do. Your child’s doctor can help you decide which would be best for your child. Here are some tips and treatments:
- Be patient and understanding—most kids will become dry without treatment.
- If an adult in your family used to wet the bed, have them talk to your child about it. Then your child will not feel so alone or ashamed.
- Respect your child’s privacy, and do not talk about the bed-wetting in front of others.
- Have your child change their pajamas and the wet bedding themselves. (But just have them do it in a matter of fact, “taking responsibility for themselves” kind of way—not as a punishment.)
- Younger kids may want to wear a “pull-up” over their underwear, so that they can feel that they are wet, but not get the bedding all wet.
- Use a reward system, such as a sticker chart on the bedroom wall for dry nights. Put the focus on being dry, to keep the tone positive.
- Make sure your child drinks lots and lots of water early in the day.
- Have your child go to the bathroom to empty the bladder right before bedtime.
- Make sure your child is getting enough sleep.
- Eliminate caffeine and allergy-causing foods, which can irritate the bladder.
- Restrict fluids after dinner—but make sure your child drinks very well throughout the rest of the day, especially in hot or dry weather.
- Wake your child up in the middle of the night, a little earlier than they usually wet the bed, and walk them to the bathroom to pee, then back to bed (called “night lifting”). This doesn’t teach the child to be dry, but does keep the bed dry, until the child develops the ability to stay dry themselves.
- Use hypnosis and guided imagery (see the recommended book below—Dry All Night, by Alison Mack.). This is both very safe and very effective.
- Try a bed-wetting alarm. These have a sensor that goes in the underwear and sets off an alarm if it gets wet. Theoretically, it is supposed to wake the child so they will stop the urine flow, and go to the bathroom. Sometimes, it wakes the parents before it wakes the child. Then the parents need to get involved, and continue their involvement, until the alarm begins to wake the child. It usually takes about six to eight weeks of using the alarm to achieve dryness. Many kids will be helped by it if it is used consistently, and most will stay dry permanently.
- As a last resort, your doctor may prescribe medication. It can be used short-term (like for summer camp), or for long-term treatment. You and your child’s doctor will need to watch your child’s response to the medication. Medications will help most children, but once they stop taking the medicine, the bed-wetting will usually continue.
- Tofranil (imipramine) is believed to work by relaxing the bladder during sleep.
- DDAVP (desmopressin) is similar to the hormone vasopressin. It signals the kidneys to make less urine at night. It comes in pill and nasal spray forms. It is more expensive than imipramine. DDAVP can be used just for one night—for example to get through a sleepover. It doesn’t work for all kids.
- Detrol (tolterodine) is an anti-spasmodic, and helps stop wetting caused by bladder spasms.
Dry All Night: The Picture Book Technique That Stops Bed-wetting, by Alison Mack.
This book begins with great information for parents, and the rest of the book is for children. The book uses facts, guided imagery, and the power of suggestion to help your child to learn to wake up and go to the bathroom at night when their bladder is full.
Here is a list of more bedwetting resources, including books for kids and adults.
- The National Kidney Foundation offers bed-wetting information and helps support scientific research about bed-wetting.
- Just for kids: Bed-wetting.
- Just for teens: Bed-wetting self-care
- YourChild: Toilet Training
- YourChild: Encopresis (Constipation and Soiling)
- YourChild: Sleep Problems
- YourChild: Pediatric Hypnotherapy: Hypnosis Helping Kids
Written and compiled by Kyla Boyse, R.N. Reviewed by Barbara Felt, M.D.
Updated September, 2008