Bedwetting (Enuresis)

If your child wakes up in the morning embarrassed because, yet again, the bed sheets and pajamas are wet in urine, please don’t get anxious! This will not continue forever. Bedwetting is not due to some emotional or psychiatric problems. Be patient with your child and make sure you are supportive; allow the child to feel confident that they will be dry at night, eventually.

Bedwetting is also known by the medical term, nocturnal enuresis. It means urinating during sleep at an age where it is not expected. It is common in children, a little more in boys than girls. It tends to run in families. It is most often not due to a medical or emotional problem, just developmental delay that does not harbor any long term consequences. Only in rare cases (10%), it means a medical problem that needs medical attention.

Normally, as the child’s bladder grows larger and bladder control matures, he or she is able to stay dry for longer periods during the day and night. By age 5 years, children begin to develop nighttime dryness.

In adults or older children, bedwetting does not happen because of two reasons:

  1. The ability to wake up when the bladder is full.
  2. The effect of a hormone called vasopressin which is released around evening/night time which tells the kidney to slow down urine production. Children develop this cycling of vasopressin around age 2 years.

 Medical conditions that can cause bedwetting should be kept in mind for children and adults. They include bladder infection, excessive caffeine or alcohol consumption (both are diuretics- meaning they increase the making of urine), neurological disorders (seizures, multiple sclerosis, stroke, spinal cord injury, mentally challenged individuals), medications (diuretics for hypertension), anatomical abnormalities such as small bladder, enlarged prostate, sleep apnea, and sleep walking. At times, bedwetting can be the result of anxiety or stress (divorce of parents, new sibling).

Bedwetting can disrupt the quality of sleep and affect the social life of the child (sleep-overs become problems).

 Tips for management of bedwetting

  • The most important part of the management is to make sure that the child does not suffer shame or embarrassment from the parents, siblings or friends. Rather, parents need to be supportive till the child grows out of it, typically by age 10. There is no need to get angry because the sheets are wet of urine. Yes, it is more work to clean the sheets, but it is not worth putting this child through bad feelings.
  • Waiting for the development is the first line of treatment unless a medical condition is suspected and needs to be addressed by the urologist. Talk to your pediatrician if you have initial concerns.
  • Limit the amount of liquids in the late evenings. Avoid dinners that are salty (to avoid thirst close to bedtime).
  • Give positive reinforcement in the morning when the child wakes up dry.
  • Use diapers and water resistant mattress pads.
  • Alarms can also be helpful. They will sound with moisture.
  • Medications: Discuss this with your pediatrician
  • Desmopressin tablets which reduce urine production at night