Bedwetting is common for children, affecting more boys than girls. The condition occurs in approximately 15% of children at the age of 5 years, 7% of children at the age of 8, and declines to 1% to 2% of children by the age of 15 years. It continues to affect 0.5% into adulthood. Although children develop bladder control at different rates, most boys can control their bladder during the day and night by the age of 6, and most girls by the age of 5. When a child who is old enough to have bladder control urinates accidentally while sleeping, it’s called nocturnal enuresis.
There are two main types of nocturnal enuresis: primary and secondary. The primary type is a condition where a child still wets the bed after age 5 or 6. It’s often hereditary. The secondary type occurs when a child who had stopped bedwetting for at least six months starts again, often due to emotional stress or a medical condition.
Possible causes of primary nocturnal enuresis include the following:
Rare possible causes include the following:
Although it is often said that emotional stress causes primary nocturnal enuresis, there is little scientific evidence to support this claim. However, bedwetting itself may lead to feelings of shame and lowered self-esteem.
Causes of secondary nocturnal enuresis include the following:
For sleeping children who are old enough to control their bladders, the symptoms of bedwetting are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them.
The most common complication of bedwetting is the impact on self-esteem and the emotional distress it causes children. Assuring children that the occurrences are accidental (and not blaming the condition on them) is key to managing the psychological effects. Many children who wet the bed may fear staying overnight at a friend’s house in case they wet the bed there.
Since many children under the age of six still wet the bed, any one of the following signs should signal the need to consult a doctor:
Laboratory tests can be done to make sure the bedwetting isn’t caused by a urinary tract infection or by other medical conditions such as diabetes. Treatment can be started if these medical conditions are found.
Children under the age of 5 or 6 aren’t treated for bedwetting because they generally outgrow the problem.
Here are some strategies for parents to help children who are wetting the bed:
Actively treating bedwetting may be helpful if a child’s relationships or school performance are being significantly affected. Treatment may involve bedwetting alarms or medications.
A bedwetting alarm is triggered when the child passes the first few drops of urine and wakes him or her up. Alarms become effective for most children after they have been used for 12 weeks. Alarms are most effective for children over 7 or 8 years of age. For alarm treatment to be successful, the child must be motivated and the parents must be willing to have their sleep interrupted. In some cases, the child may not be woken up by the alarm during the first few weeks, and parents must wake the child.
Medications are another option for bedwetting. Children 5 years of age and older may take desmopressin,* a medication that decreases the amount of urine the body makes, but this won’t stop bedwetting completely. Special care should be made to avoid drinking fluids one hour before and eight hours after taking this medication. Side effects include sinus congestion, runny nose, headache, and abdominal pain.
Another option is a medication called imipramine, which is also available for children older than 6 years. Imipramine belongs to the class of medications called tricyclic antidepressants. It works immediately to prevent bedwetting. Side effects such as changes to sleep patterns, headache, and appetite changes may occur. Like all medications, imipramine needs to be safely stored away from children between doses.
If there are family problems (psychiatric or emotional) affecting either the child or another member of the family, these may also be root causes of bedwetting and need attention. Otherwise, the bedwetting can lead to life-long emotional and psychological distress.
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