Written by Dr. Scott Steinberg
Nighttime urinary incontinence is a very common occurrence in children, affecting about fifteen percent of 5-year olds, five percent of 10-year olds and even one to two percent of fifteen-year olds. Sometimes it can be embarrassing for the child, and it can be the source of worry for parents. However, overnight bedwetting without any daytime wetting or other urinary complaints is not typically a medical problem.
Some reasons why it may take longer to achieve dryness include:
- Deep sleepers aren’t able to wake up to the full bladder signal
- They might have a smaller bladder that is unable to hold urine for a full night
- Family history of bedwetting
- Your child’s body produces too much urine overnight
- Constipation; pressure on the bladder from full bowels can cause accidents
- Minor illness, overly tired or response to stresses at home
- An underlying medical problem
The problem usually disappears as children get older. If children reach school age and still have problems wetting the bed, it most likely means they have never developed nighttime bladder control. Bedwetting into the older childhood years tends to affect boys more than girls.
Some tips for managing bedwetting include:
- It is not an intentional behavior, so avoid punishment
- Be sensitive to your child’s feelings by not making a big issue out of bedwetting
- Encourage your child to urinate regularly during the day, including before bed
- Involve your child in cleaning up in the morning in a nonpunitive fashion
- Limit sugary and caffeinated drinks
- Avoid drinking large amounts of fluids before bedtime, encourage fluids earlier in the day (do not restrict fluids)
- Use a waterproof mattress cover
- Make a “No Teasing” policy for your family. Do not let family members, especially siblings tease your child about this issue.
If your child isn’t responding to the tactics listed above, a bedwetting alarm may be recommended. These make sound or vibrate when a sensor detects the first drops of urine in the underwear. Using an alarm takes a good deal of motivation and should be continued until a child has 3-4 weeks of dry nights. In general, alarms are used for children six years of age or older, but can be used for younger kids who are very motivated. The idea is that at that point, the child has been "trained" to wake up at the very beginning of urination without the coupling of the alarm.
Another therapy is a medication called DDAVP or desmopressin. This is a pill that can be taken at bedtime and usually reserved for children 8 years of age or older. It decreases urine production overnight so one's bladder doesn't fill up. Unlike the alarm, it does not "cure" bedwetting. It tends to be used for brief periods like summer camps or sleepovers when bedwetting can be more distressing to kids. However, it can be used long term. Sometimes my preteens or teens just simply want a break from wetting and bed cleaning. Side effects from DDAVP are uncommon, but please speak with your provider if this is something that may work for your child.
Beware of programs and devices claiming a “cure” for bedwetting. These products tend to make false claims and can get very expensive. Your child’s doctor is always the best source for advice about bedwetting.
Keep a Positive Outlook
Try not to be discouraged, sometimes children end up responding best to a combination of treatments. Bedwetting will almost always decrease as your child’s body matures. Your child will need emotional support from your family as they outgrow this. You can always get extra support from a pediatric urologist, their doctor or a mental health professional.
Dr. Scott Steinberg joined Northeast Cincinnati Pediatrics in 2003. He has availability on Monday, Tuesday and Friday in Blue Ash; and alternates Wednesdays between Blue Ash and Mason.