When Is Bedwetting in Children a Problem?

Bedwetting is something parents often mention with embarrassment, yet it is very common in childhood. In most children it becomes less frequent with age and stops on its own. Even so, some signs show that an underlying problem should be looked into.

When is bedwetting considered a problem?

Bedwetting, medically called enuresis, is when a child over the age of 5 wets the bed during sleep. Not yet being dry at night before the age of 5 is mostly part of normal development.

There are two main types:

• Primary enuresis: The child has never been dry at night for a long period. This is the most common type.
• Secondary enuresis: The child starts wetting again after having been dry for at least 6 months.

In addition, children who only wet at night are assessed differently from those who also have daytime leaking, go to the toilet very often or have sudden urgency. If there are daytime symptoms, bladder function needs to be looked at in more detail.

What causes bedwetting in children?

There is usually no single cause of bedwetting; several factors come together:

• Producing a lot of urine at night: A hormone normally released at night reduces the amount of urine the kidneys produce. In some children this pattern has not yet settled.
• A small bladder capacity, or a tendency of the bladder to contract before it is full.
• Deep sleep and difficulty waking: The child does not wake up to the signal of a full bladder.
• Family tendency: It is more common in children whose mother or father wet the bed as a child.
• Constipation: A full bowel can press on the bladder and disrupt bladder control.
• Snoring and sleep apnoea: Pauses in breathing during sleep due to large tonsils or adenoids can increase bedwetting.

Less often, a urinary tract infection, diabetes, or problems related to the kidneys or spinal cord may also be part of the picture. For this reason, these possibilities should be ruled out, particularly when there are daytime symptoms or when the wetting started later.

Is bedwetting psychological?

In most cases bedwetting is not a psychological problem; it is largely due to developmental and biological causes. However, stressful events (starting school, moving house, the birth of a sibling, family problems) can trigger secondary enuresis in particular.

On the other hand, bedwetting itself can affect a child’s self-confidence. Not being able to stay over at a friend’s house or go on a school trip or camp can upset a child. For this reason, how much the child is bothered by it is also taken into account when deciding on treatment.

What can parents do at home?

Whatever the treatment, the family’s attitude is the most important part of the process. Practical tips:

1. Do not blame or punish. A child cannot control what happens during sleep. Scolding and teasing make the problem last longer.
2. Spread drinks across the day. Make sure your child drinks enough water during the day, especially in the morning and at midday, and cut down on drinks in the evening.
3. Send your child to the toilet before bed. Make passing urine just before going to bed part of the evening routine.
4. Limit caffeinated and sugary drinks in the evening. Cola, tea and fizzy drinks can increase urine production.
5. Prevent constipation. A diet rich in fibre and regular toilet habits are important.
6. Reward dry nights. Marking dry nights on a simple calendar or star chart motivates the child.

Lifting a sleeping child at night and taking them to the toilet may help some nights stay dry, but it does not teach the child to wake up by themselves. Continuing to use night-time nappies or pull-ups for a long time is also not usually recommended.

How are alarms and medication used to treat bedwetting?

If the wetting continues despite measures at home and the child is bothered by it, there are two main treatment options:

• Bedwetting alarm: A sensor that detects the first drops alerts the child with a sound or vibration. Over time, the child learns to notice a full bladder. The effect tends to be lasting, but it can take a few weeks to a few months to see results, and it needs patient involvement from the family.
• Medication: Medicines that reduce urine production at night can work quickly, especially in children who produce a lot of urine at night. While using these medicines, the evening fluid restriction recommended by the doctor must always be followed. In some children, the wetting can start again when the medicine is stopped.

Which method is chosen depends on the child’s age, how often the wetting happens, any daytime symptoms and the family’s routine, all considered together. In some children both methods can be used together. Medication should not be started without a doctor’s recommendation.

At the consultation, a detailed history is usually taken, a urine test is done and the family is asked to fill in a bladder diary over a few days. If necessary, the kidneys and bladder are assessed with an ultrasound scan. Op. Dr. Mücahit Kabar has also published a scientific study in an international journal on night-time wetting and the bladder wall in children. For more information on urinary problems in children, see the paediatric urology page.

When should you see a urologist?

It is advisable to have your child assessed by a urologist in the following situations:

• Regular bedwetting continuing after the age of 5
• Daytime wetting, sudden urgency or going to the toilet very often
• Wetting that starts again after being dry for at least 6 months
• Burning when passing urine, fever, or a stop-start or weak urine stream
• Drinking excessively, passing a lot of urine or losing weight
• Marked snoring, constipation or soiling

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish; the hospitals’ international patient departments can arrange interpreters for other languages. Families travelling from abroad can send questions or reports by WhatsApp to +90 541 622 54 82 before their visit. Further details are on the contact page.