Definition
Bed-wetting is when a child over 5 years old urinates during sleep.
| Urinary System in Child |
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Causes
Bed-wetting is common and not usually related to a health problem. Causes may be:
- Drinking too much fluid before bed
- Constipation
- Developmental delay problems
Rarely, a health problem may cause bed-wetting. Examples are:
- Psychological triggers, such as moving to a new home or the death of a loved one
- Attention deficit hyperactivity disorder
- A sleep disorder, sometimes related to enlarged tonsils or adenoids
- Diabetes insipidus—a rare disorder in which sugar is normal but excess water is excreted by the kidney
- Kidney disease
- Bladder obstruction
Risk Factors
Bed-wetting is more common in boys before 9 years old. Other things that may raise a child's risk of this problem are:
- Family members with a history of bed-wetting
- Chronic constipation
- Anxiety
- Sleep apnea
- Sickle cell disease
Diagnosis
You will be asked about your child's symptoms and health and family history. You will also be asked how often and how long your child has been wetting the bed. A physical exam will be done. Bed-wetting is often diagnosed in children over 5 years old who wet the bed more than twice a week for 3 months or more.
Blood or urine tests may be done to find out whether an illness is causing this problem.
Images may be taken when the doctor suspects an abnormality may be the cause of the bed-wetting. This can be done with:
Treatment
Any underlying health problems that cause bed-wetting will be treated. Bed-wetting that is not due to a health problem often goes away on its own. The goal of treatment is to limit the number of bed-wettings. This can be done with:
Motivation and Family Support
Bed-wetting is not done on purpose. Punishing a child will not limit the number of bed-wettings. Encouragement and support should be given instead. Limiting fluids and urinating before bedtime may also help. Caffeine should be avoided.
Behavioral Therapy
Urinating at regular intervals during day and before sleep may also help.
A behavioral device may also be advised. One example is a pad with a buzzer that sounds when wet. The pad is worn in the child's underwear. The alarm will wake the child to use the toilet.
Medicine
Medicine may be given, such as:
- A hormone that decreases the amount of urine that is made
- An antidepressant that lightens the level of sleep and may also decrease how often the child urinates
- A medicine to reduce bladder overactivity and the frequency of nighttime wetting
RESOURCES
American Academy of Child & Adolescent Psychiatry http://www.aacap.org
Healthy Children—American Academy of Pediatrics http://www.healthychildren.org
CANADIAN RESOURCES
About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca
Alberta Health and Wellness http://www.health.alberta.ca
References
Bedwetting. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Bedwetting.aspx. Updated September 6, 2013. Accessed January 8, 2020.
Enuresis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/enuresis . Updated October 26, 2017. Accessed January 8, 2020.
Facts for families: bed wetting. American Academy of Child and Adolescent Psychiatry website. Available at: https://www.aacap.org/AACAP/Families%5Fand%5FYouth/Facts%5Ffor%5FFamilies/FFF-Guide/Bedwetting-018.aspx. Updated December 2014. Accessed January 8, 2020.
Sinha R, Raut S. Management of nocturnal enuresis - myths and facts. World J Nephrol. 2016 Jul 6;5(4):328-338.
Revision Information
- Reviewer: EBSCO Medical Review Board Kari Kassir, MD
- Review Date: 09/2019
- Update Date: 08/12/2020