Bedwetting Affects Children of all Ages, Here’s How to Help

Montefiore is offering tips to stop child bedwetting. -File photo

By Dr. Miriam Harel, Pediatric Urologist, Children’s Hospital at Montefiore

HEALTH - If you think your child is the last one in class still wetting the bed, trust us, you are definitely not alone! 

Approximately 10% of six-year-olds still wet the bed every night, and 5% of all 10-year-olds are still waiting to outgrow it. This means that over five million children in the U.S. have bedwetting. While bedwetting is not physically harmful, it can often lead to poor self-esteem and avoidance of social activities such as camp and sleepovers, if left untreated. 

Bedwetting can also be very frustrating, expensive, and time-consuming for parents. In the department of pediatric urology at Montefiore, we have a whole team of doctors and nurses committed to helping you understand and treat your child’s bedwetting.

What Causes Bedwetting?

Bedwetting is due to a combination of factors, including family history of bedwetting (genetics), small bladder capacity, and possibly too much urine production at night. Additionally, most parents will agree that children who wet the bed are very deep sleepers, and they don’t wake up from the bladder’s signal to urinate. Constipation is also common among these children, and a full rectum can put pressure on the bladder and make it difficult for the bladder to hold urine, during the day or nighttime. 

In some children, sleep disorders (sleepwalking or heavy snoring) may also contribute to bedwetting. It is important to remember that bedwetting is never the child’s fault and is not happening on purpose, or out of laziness. 

How do we Evaluate Children with Bedwetting?

Perhaps the most important part of evaluating your child is taking a thorough history to learn about their urinary patterns and to determine if they have accidents during the daytime or any other urinary symptoms besides bedwetting alone. We will also ask questions about your child’s bowel movements as well as other conditions that might be related to bedwetting, such as sleep problems or behavioral concerns. The physical examination is not painful. A urine sample is often obtained, and sometimes an ultrasound of the kidneys and bladder can also be helpful to gain more information about your child’s bladder function.

What Treatments are Available?

It is important to remember that most cases of bedwetting will resolve on their own, therefore, if your child is young enough and is not bothered by the accidents, it may be an option to give him/her more time to outgrow it without active treatment. An important part of this approach is making sure that your child’s daytime habits are appropriate. This involves timed voiding, or having children urinate every two hours during the daytime, as well as making sure that they are drinking enough water and limiting their intake of soda or juices, which can irritate the bladder.  Treatment of constipation is also extremely important. Approximately 20% of children may stop wetting the bed with these measures alone. 

Additional treatment options for bedwetting include medications or bedwetting alarms:

• The most commonly used medication for bedwetting is desmopressin, or DDAVP. This pill is taken about one hour before bedtime and works by decreasing the amount of urine that the body produces at night. The medication is very safe as long as you limit your child’s fluid intake in the evening. The pills don’t cure your child’s bedwetting, but they can help to keep your child dry while they are developing and maturing. The medications can be used every night or only for sleepovers. 
• Bedwetting alarms work by waking your child up when they start to have an accident, so they can then go to the bathroom to finish urinating. Over time, children learn to wake up on their own when their bladder feels full. It is important to note that waking up your child at random times throughout the night to go to the bathroom does not seem to help in the long run, but the alarm, while it requires more work than the pills, can actually cure bedwetting permanently. 

If these treatments don’t work for your child, then there are other tests that can be considered to better understand your child’s bladder function or other medications that can be tried.

Dr. Miriam Harel, Pediatric Urologist, Children’s Hospital at Montefiore

While bedwetting is not physically harmful and usually resolves on its own over time, there are treatments available if it is affecting your child’s quality of life. Our pediatric urology team at Montefiore is always available to help reassure your child that he/she is not alone and to help come up with a treatment plan tailored specifically to your child’s needs.