Bed-wetting (nighttime incontinence)

What is Nocturnal Enuresis?
Bed-wetting is involuntary urination while asleep.

Generally, bed-wetting before age 7 is not a cause for concern. At this age, a child's bladder control is still developing. It is almost never done on purpose.

Is it Normal?

Most kids are toilet trained by age 4, but nighttime control takes longer.

• Age 5: Bed-wetting is still a problem for about 15% of children.
• Age 10: Fewer than 5% of children still wet the bed.

⚠️ WHEN TO SEE A DOCTOR
Consult your pediatrician if:

• Your child starts wetting the bed after being dry for at least 6 months (Secondary Enuresis).
• There is pain or burning with urination.
• The urine is pink or red.
• The child snores loudly (Sleep Apnea link).
• The child is excessively thirsty (Diabetes link).

Causes

No one knows the exact cause, but several factors play a role:

1. Biological Factors

• Small Bladder: The bladder isn't developed enough to hold urine all night.
• Deep Sleep: The child sleeps so deeply that a full bladder doesn't wake them up.
• Hormone Imbalance: Some kids don't produce enough ADH (anti-diuretic hormone) to slow urine production at night.

2. Medical Conditions

• Constipation: A full bowel presses against the bladder, reducing its capacity.
• Diabetes: Bed-wetting in a previously dry child is often the first sign of Type 1 Diabetes.
• Sleep Apnea: Interrupted breathing due to enlarged tonsils can trigger bed-wetting.
• UTI: Urinary Tract Infections make it hard to control urination.

Complications

The primary risk is Low Self-Esteem. Children often feel guilty or embarrassed. Physically, sleeping in wet underwear can cause rashes on the bottom and genitals.

Diagnosis

Doctors perform a physical exam and may order:

• Urine Tests: To check for infection or diabetes.
• X-rays: To look for structural problems in the kidneys or bladder (rare).

Treatment

Treatment is usually reserved for children older than 7 or those who are distressed by the condition.

1. Moisture Alarms (The Gold Standard)

Small, battery-operated devices connect to a pad on the pajamas. When it senses moisture, it sounds an alarm to wake the child. It takes time (up to 12 weeks) but is highly effective for long-term success.

2. Medication

Medication treats the symptoms, not the cause. Bed-wetting often returns when the medicine stops.

• Desmopressin (DDAVP): A synthetic hormone that reduces urine production at night.
• Oxybutynin (Ditropan): Relaxes the bladder muscles to increase capacity.

3. Home Strategies

• Limit Fluids: Reduce fluid intake 2 hours before bedtime.
• Double Voiding: Have the child urinate at the beginning of the bedtime routine and again right before falling asleep.
• No Punishment: Never punish or tease a child for wetting the bed. It is not their fault.

Disclaimer: The content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician regarding any medical condition.