Child and Adolescent Psychiatrist Dr. Erdem Beyoğlu
Bed-Wetting — also called Nighttime Incontinence or Nocturnal Enuresis — is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.
Bed-wetting isn’t a sign of toilet training gone badly. Don’t despair. It’s often just a normal part of a child’s development. Generally, bed-wetting is normal till 6 years old. Till this age, your child may still be developing nighttime bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet their bed. Some of children may need help but generally the bladder maturates spontaneously and most children control their bladder in time.
There are two types of nocturnal enuresis. The testing, care and treatment for both types are very similar:
- Primary nocturnal enuresis describes children who never achieved dry nights since potty training (typically these children have no accidents during the day time)
- Secondary nocturnal enuresis is when a child achieved consistent dry nights for at least six months but has now started bedwetting again. Mostly, this type of bedwetting is related to a stressful event (e.g. birth of a sibling, parent divorce, etc.). Eating disorders and some medicines can cause secondary bedwetting.
Several factors have been associated with an increased risk of bed-wetting, including:
– Stress and anxiety. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
– Family history. If one or both of a child’s parents wet the bed as children, their child has a significant chance of wetting the bed, too.
– Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.
In some cases, bed-wetting may be a sign of an underlying condition that needs medical attention. You can find these conditoins below:
– A small bladder. Your child’s bladder may not be developed enough to hold urine produced during the night.
– Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
– A hormone imbalance. During childhood, some kids don’t produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
– Urinary tract problems or infection. The Urinary infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination. Rarely, bed-wetting is related to a defect in the child’s neurological system or urinary system.
– Sleep disturbance problems such as apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child’s breathing is interrupted during sleep — often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring and daytime drowsiness.
– Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
– Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
The treatment is focused what is the problem exactly.
There are many treatments for bedwetting, some work better than others. Often, treatment starts with simple changes like:
- Reducing the amount of fluids your child drinks 1-2 hours before bed
- Creating a schedule for bathroom use (changing toilet habits)
- Wetting alarm devices
- Prescription Drugs
These strategies may be tried one at a time, or together.