BEDWETTING: MORE COMMON THAN PARENTS MIGHT THINK

Bedwetting, or nocturnal enuresis, is a common issue many children face as they grow and develop. Many children are fully toilet trained (and no longer wetting the bed at night) by four years of age. However, bedwetting may continue for some children.

While it can be frustrating for both kids and parents, it’s important to remember that bedwetting is usually a phase that most children outgrow. However, understanding the underlying causes and knowing how to approach the situation with patience and support can help reduce stress and promote positive outcomes.

POSSIBLE REASONS FOR BEDWETTING
Constipation: Constipation can put pressure on the bladder, making it more likely to leak.
Developmental delay: In young children, the bladder may not be fully developed and may not be able to hold urine through the night. A common cause is delayed maturation – the brain cannot control the bladder while sleeping.
Heavy sleepers: Bedwetting is often seen in heavy sleepers, or some kids that just will not wake to empty the bladder.
Genetics: Bedwetting can run in families – it’s often seen in families where other family members were late to potty train (50% chance for a child if one parent wet the bed, 75% if both parents were late to potty train).
Small bladder capacity: Some children may have smaller bladders than others, making it more difficult to hold urine overnight.
Hormonal imbalances: Certain hormones, such as antidiuretic hormone (ADH), can affect bladder function.
Stress or anxiety: Emotional factors can sometimes contribute to bedwetting.

Bedwetting is also associated with sleep apnea, ADHD, and autism.

MANAGEMENT
It is important to understand that most children have no control over bedwetting, so getting angry or upset never helps. Most children will simply grow out of bedwetting.

For others, they may need other strategies and coaching to success:
• Avoid constipation with a diet of fruits and vegetables; drink more water.
• Use positive rewards for a successful night of sleep.
• Kids that are dehydrated have more problems with bed wetting, so do not restrict fluids.
• Use timed voids to help with bladder function, having the child urinate and drink water about every two hours.
• Consider the use of pull-up training underwear: opinions vary on their use. Some parents feel they may enable bed wetting while other parents feel that since they cannot control bedwetting, use the pull-up training underwear to avoid the accidents. Typically, you can try removing pull-up training underwear when kids have been dry for two to three weeks.
• Some families use an alarm to schedule bathroom visits during the night. Research on this approach is limited and most of what I hear from parents is that the alarm wakes everyone else up…no one gets a good night of sleep!
• For kids that have prolonged bed wetting and disordered sleeping, waking them up to urinate only further disrupts the sleep and does not train the bladder.

EVALUATION
While bedwetting is not a medical condition, you may decide to seek advice from your CPCMG pediatrician. They may:
• Ask questions related to other urinary symptoms, daytime accidents, frequency or urgency.
• Test your child’s urine to rule out infection.
• Request an x-ray or ultrasound to confirm constipation or other condition.
• Recommend medication for use on a short-term basis.

If you have any concerns about your child and bedwetting, please reach out to your CPCMG pediatrician.