Bedwetting in Kids

It’s happened again — your child has wet the bed. They’re upset, and you’re frustrated. What should you do? 

“Bedwetting is a common problem,” says Reumah Ravoori, MMS, PA-C, a physician assistant in urology at Lurie Children’s. “You and your child are not alone.”

The uncontrolled release of urine from the bladder (enuresis) happens to many kids. In nocturnal enuresis, this release happens at night while a child is sleeping. At age 5, about one in five children have nighttime accidents.

Why is my child wetting the bed?

Bedwetting isn’t anyone’s fault, according to Lynn Freedman, MSN, MPH, APRN-NP, CPNP, an advanced practice provider in urology at Lurie Children’s. 

“We sometimes hear parents wonder if they failed to potty train their child correctly,” she says. “That’s not the case.”

Most children stop wetting the bed between the ages of 3 and 5. Many have occasional accidents before they’re able to stay dry all night. If your child is 5 or older and releases urine during sleep more than once a month, talk to their healthcare provider.

Types of Bedwetting

Bedwetting occurs for different reasons. A child may experience:

Primary Enuresis

Kids with primary enuresis haven’t achieved consistent nighttime dryness yet. This is the most common type of bedwetting. Primary enuresis may occur due to:

Immature Bladder and Brain Connection

Peeing the bed may happen when the connection between a child’s brain and bladder hasn’t fully matured. It can also happen in kids who are heavy sleepers. 

“The bladder isn’t giving the brain a good signal to wake,” Freedman says. “Often, that’s more common in a kid who’s a deep sleeper. Eventually, the brain tells the bladder to hold urine through the night.”

Although most kids can make it through the night by age 5, this connection takes extra time to mature in some children. Bedwetting may also run in families, according to Ravoori. Kids who wet the bed may have parents who experienced bedwetting at about the same age. 

Bladder Dysfunction With Constipation

Constipation plays a role in bedwetting for some kids. This is because the end of the colon — primarily the rectum — sits against the bladder. When stool (poop) collects in the colon, it reduces the bladder’s size temporarily. Less room to store urine creates a more urgent need to urinate or may cause the bladder to release urine.

Constipation also compresses nerves shared by the bladder and rectum. Your child may feel like they need to pass stool, but instead, their bladder releases urine. The relationship is so strong that when healthcare providers treat constipation, about half of kids stop wetting the bed, Ravoori says.

Secondary Enuresis

If your child has been dry at night for at least six months but is now wetting the bed, talk to their healthcare provider. Some underlying health conditions may cause nighttime wetness. 

About one in five kids who wet the bed has a health condition that affects their ability to hold urine through the night, according to Ravoori. Secondary enuresis may result from: 

• Anxiety
• Attention deficit hyperactive disorder (ADHD)
• Diabetes
• Neurogenic bladder
• Obstructive sleep apnea
• Urinary tract infections

Rarely, certain structural differences in the body’s urinary system can cause bedwetting. These differences include:

• Ectopic ureter
• Posterior urethral valves

Some children also have smaller bladders. Healthcare providers may diagnose a small bladder or other physical differences through imaging studies

Finding the Cause of Bedwetting

Your child’s healthcare provider can help you learn why your child may be wetting the bed. They examine your child and talk with you about their medical history. Most children who wet the bed don’t have an underlying medical condition, but your provider may do certain tests to be sure. 

If your child has certain symptoms, your provider may recommend a:

• Urine test: Providers check a sample of your child’s urine for blood or protein. They may also check urine concentration. These tests help identify metabolic conditions like diabetes and kidney conditions.
• Blood test: Providers test a small sample of your child’s blood. They use these tests to check for anemia, diabetes and hormone issues. These tests also help providers diagnose problems with the kidneys and thyroid.

If your child has an underlying medical condition, providers treat the condition first. This treatment may stop your child from wetting the bed. 

Bedwetting Treatments

Lifestyle changes and certain treatments help many children with primary enuresis and secondary enuresis. To help keep your child dry at night, healthcare providers may recommend:

Bedwetting Alarms 

An alarm containing a moisture sensor can help develop the connection between a child’s brain and bladder. While alarms don’t catch accidents ahead of time, they trigger a noise that wakes the child and parents.

Alarms work for four out of five children, according to Freedman. “It can be a hard process and can take three months or so to work,” she says. “It’s a family commitment that requires adult involvement. When the alarm goes off, parents need to help their child wake and go to the bathroom to finish peeing.”

Good Bladder and Bowel Habits

Kids often benefit from changes that help them learn to recognize bladder cues during the day. A healthcare provider can work with you and your child to establish a bladder and bowel regimen. “A good regimen helps get them to dryness faster than they might be able to do on their own,” Ravoori says.

To establish good toilet habits, you should:

• Avoid serving caffeine, carbonated drinks, citrus juices and dairy after dinner: These drinks may irritate your child’s bladder.
• Encourage kids to urinate every two to three hours during the day: This habit helps your child learn to pay attention to bladder cues.
• Have your child drink more fluids during the day: Shifting fluid intake helps kids stay hydrated, reducing the need to drink fluids in the evening.
• Limit drinks in the two hours before bedtime: Limiting evening drinks helps decrease the amount of fluid in your child’s bladder overnight. But don’t limit drinks if your child has any signs of dehydration, such as excessive thirst or dark urine. Instead, talk with your healthcare provider if your child has these symptoms or if they have a health condition. 
• Make sure your child tries to have a bowel movement every day: Regular bowel movements help prevent constipation. Talk to your child’s pediatrician if your child experiences a change in bowel habits or has trouble with bowel movements. 
• Remind your child to urinate right before bed: A bathroom trip to pee before settling down to sleep helps make sure your child’s bladder is empty.

Laxatives or stool softeners can help some kids who have trouble with regular bowel movements. Talk to your healthcare provider before using these treatments. 

“At night, the kidneys are sending urine to the bladder, and the colon is sending stool to the end of the rectum,” Ravoori says. “One will run out of space, and it’s easier for the bladder to leak than it is for the colon. While we’re working on getting them to wake up to urinate, it’s easier to work on creating more space during the day versus waking them up at night.” 

Medications

Healthcare providers may recommend medications for some kids. Medications for bedwetting include: 

Desmopressin

Desmopressin is a natural hormone released by the body at night. It helps decrease urine production. “We sometimes use desmopressin for sleepovers and overnight camps,” Freedman says. “Some children may take it every day.”

Oxybutynin

Oxybutynin is a medication that helps treat an overactive bladder. It helps improve bladder capacity and reduce bladder contractions. It may help children with health conditions that affect nerves. It may also help children who have a smaller bladder than is typical. 

How can I help my child with bedwetting? 

Bedwetting can be hard on a child’s self-esteem and confidence, according to Freedman. “No child wants this,” she says. She notes that punishing children for bedwetting may cause more problems in the long run.

Talk with your child about bedwetting. Let them know it’s not their fault. If you wet the bed as a child, it may be helpful to share your own experience. 

When will bedwetting resolve?

Many children stop bedwetting in as little as three months. It often takes patience and encouragement. But some children may take as long as a couple of years, according to Ravoori.

Contact your child’s healthcare provider if bedwetting continues. Get in touch right away if your child has:

• Blood in their urine
• Pain 
• Persistent loud snoring
• Trouble holding urine during the day

Let your child’s provider know if you notice any sudden changes in how your child walks. Certain neurological conditions can cause problems with nerves that affect movement and urination. 

If you’re concerned about bedwetting in a child older than 5, don’t wait to get help, Ravoori says. “Treating is important versus waiting for them to outgrow it,” she says. “There’s a big psychosocial impact on the child and their confidence.” 

Talk to your child’s primary care provider if your child is wetting the bed. They can help you determine if your child may benefit from seeing a specialist.

Learn more about the Bladder Function Improvement Training (BFIT) program at Lurie Children’s. 

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