Why Bedwetting Happens to Kids and Teens - and What Actually Helps
- Sheila Thompson, RN CPHQ
- 3 minutes ago
- 7 min read
If your child is still wetting the bed, you’re not alone—and more importantly, it’s not their fault. Bedwetting is common, treatable, and almost always temporary. Here’s what parents need to know to help their child with confidence.
Bedwetting at night is called nocturnal enuresis and it may continue to occur in older kids and even teens. It happens more often than you probably think, but it can be frustrating and worrisome.
Primary enuresis is when a child has always wet the bed and has never had control of their bladder at night.
Secondary enuresis means the child was dry at night for at least 6 months at some point but later begins wetting the bed again and is no longer able to control their bladder at night.
According to the National Kidney Foundation, nocturnal enuresis affects boys 2 to 3 times more than girls. It’s common for young children to have accidents occasionally after being potty trained- about 20% at age 5 and nearly 10% at age 7. Only 1 to 3% of kids still have problems in their late teens.
Impacts of bedwetting
Whatever the reason, nocturnal enuresis can affect the child and their family. The child may be embarrassed or have anxiety about having accidents and may even develop low self-esteem. They may be reluctant to have sleepovers with friends or go to an overnight camp. Travelling may be difficult if staying in a hotel or riding for long periods in a car, train, or airplane. In the home, siblings and parents may need to change sleeping arrangements or may have their sleep disrupted, plus the extra burden of more laundry. The child’s schoolwork, relationships, and quality of life may all be negatively impacted.
Causes of bedwetting
Experts believe delayed development in different parts of the body may cause bedwetting. The links between the brain and the bladder are not fully formed in babies and toddlers, so the bladder just releases urine when it feels full. Children learn to control their bladder as these links form, usually developing daytime control first, while control during sleep takes longer. One or more of these areas may be at fault:
The brain can’t make the body wake up while asleep.
The bladder isn’t large enough to hold urine all night.
The kidneys make more urine at night.
There are other factors that may contribute to the problem:
Constipation is a common factor because the bowels are very close to the bladder and may put pressure on it if full of stool. This is often one of the first things to address when a child is wetting the bed.
Genetics is likely involved, as 40% of kids with one parent who wet the bed after age 5 may also experience bedwetting, and 70% may if both parents did.
Stress is a common culprit for secondary enuresis. Kids facing major life events like moving or changing schools, discord or divorce in the home, or losing a parent or other loved one may suddenly begin wetting the bed.
Deep sleep can be typical beginning in puberty and especially for teens in high school, who may also develop poor sleep schedules or not get enough sleep.
Bladder or kidney disease may be the cause of bedwetting, particularly if it occurs during the day as well. Other symptoms such as needing to pee often or pain when peeing might occur in these cases.
Neurological diseases involving the brain or nerves may be present at birth or may develop as the child grows. This is rarely the cause of bedwetting but should be considered if the child also has numbness, tingling, or pain in the legs.
Obstructive sleep apnea, often characterized by snoring, means the child has a partially blocked airway that causes brief pauses in breathing that interfere with sleep. This can cause chemical changes in the brain that may trigger bedwetting.
Other health problems and/or medicines may lead to bedwetting in rare instances. Diabetes has been linked to bedwetting, and brain chemistry differences in children with attention deficit/hyperactivity disorder (ADHD) seem to increase the likelihood of bedwetting.
Assessing bedwetting
Your child’s health practitioner will probably begin with a complete physical exam, including a medical history. A urine test should be done to check for infection or other problems, and additional lab tests if needed. Sometimes an x-ray, ultrasound, or a test to see how strong the urine stream is or how completely your child empties their bladder is done. You will likely be asked about bathroom and sleeping patterns and may be asked to keep a diary. Questions should include how often your child pees and poops, whether either is urgent, and if there is pain when going to the bathroom. The doctor will ask what time your child goes to bed and wakes up, whether s/he snores, sleeps soundly or seems restless/wakes often, and if your child seems rested or takes frequent naps. Finally, they should ask about family history, whether either parent wet the bed, and whether your child has a lot of stress.
How is bedwetting treated?
There are many approaches to decrease bedwetting, depending on the underlying causes. Medical issues such as urinary tract infection or diabetes should be treated first, which may solve the problem quickly. Chronic constipation can take a bit longer to resolve but alleviating that pressure on the bladder can be very helpful. Provide appropriate support if stress is a factor. If the causes are more complex or less clear, additional steps include:
Lifestyle changes, such as:
Limit caffeine, salt, and sugar intake. Increase fluid intake during the day but stop drinking 2 hours before bedtime.
Make sure the child goes to the bathroom often during the day, ideally at regular times, and just before bed. Enlist the school’s support for young children.
Use waterproof bottom sheets or pads to help decrease laundry and protect the mattress. Try waking the child once during the night to see if that helps, but not more than that so their sleep is not too disrupted. Consider disposable waterproof undergarments if being wet does not wake them.
Alert camp counselors and parents hosting sleepovers that your child may need reminders or discrete help. Send extra clothes and plastic bags in case there is an accident and consider disposable waterproof undergarments.
Bedwetting alarms are very effective for many children, sometimes after just a few weeks, though it often takes 4 to 5 months. Researchers report success rates ranging from 50% to 70% with no side effects. In one study, 65% of the children achieved dryness at night and all but 1 that were followed were still dry 2 years later. The alarm buzzes or vibrates when a sensor clipped to their underwear or a pad underneath them gets wet. This helps build the link in the child’s brain by associating the alarm going off with the need to go pee, prompting them to get up and go to the bathroom. Initially, a parent will need to hear the alarm and help the child to wake up and go to the bathroom.
Medications
A drug called desmopressin is used most often and is the only one approved by the U.S. Food and Drug Administration for bedwetting. It is taken at night and works by decreasing the amount of urine the body produces. It is very effective in achieving fewer wet nights (one study found it led to 1.34 fewer wet nights per week) but unfortunately children treated with just desmopressin have a higher relapse rate at 65% compared to those using bedwetting alarms at 46%. Sometimes another drug is added, such as the anticholinergic oxybutynin, which helps relax the bladder muscles. This combination therapy is even more effective in achieving more dry nights than desmopressin alone, but the relapse rate is similar. Desmopressin can also be used only when needed to stay dry for things like sleepovers, overnight camps, and travelling.
Imipramine is another drug that may be used, alone or in combination with desmopressin or oxybutynin. It is a tricyclic antidepressant and is effective for some children, but can have serious side effects, including potential heart problems.
Posterior tibial nerve stimulation, or PTNS, is a type of neuromodulation in which a needle is placed in the lower leg to deliver electrical stimulation to the posterior tibial nerve. This nerve runs up the back of the leg and connects to the spinal cord at the same level as the nerves that affect the bladder. While the reason it works isn't entirely clear, it appears that stimulating this nerve also impacts the nerve signals that control the bladder’s function. The procedure requires 30-minute sessions performed in a medical office every week for 12 weeks, followed by sessions every 2-4 weeks for up to 2 years. PTNS is only available in a few treatment centers in the United States and very few studies have been conducted, though preliminary data suggests up to 80% of patients report improvement of their symptoms.
Complementary therapies include pelvic floor exercises, acupuncture, hypnosis, and homeopathic medicinal products, among others. While these therapies may have some positive effects and probably aren’t harmful, there isn’t much data on their effectiveness.
Summary
While nocturnal enuresis can be disruptive and challenging to treat, the good news is that most children outgrow it. Approximately 14% of children with nocturnal enuresis experience resolution each year. Of the various approaches:
Bedwetting alarms have the best long-term cure rates.
Desmopressin works the quickest but has a higher relapse rate.
Combination therapies have the highest short-term success.
Goals for a child who wets the bed include improved quality of life, self-esteem, emotional wellbeing, and relationships with family and friends. With patience and determination, most children will eventually overcome nocturnal enuresis.
Sources
Assessed and Endorsed by the MedReport Medical Review Board
