Possible triggers

Milk products before bed may make him/her sleep more soundly.
Carbonated and sweet beverages may increase urine amount.
Citrus and extra Vitamin C can cause more bladder irritability.

Things that do make a difference

Insuring enough fiber so that your child has a soft stool every day.
Making sure your child drinks enough so that they feel the need to urinate at school twice a day. Taking a water bottle to school makes this easier.
Water is the beverage of choice between dinner and bedtime. If your child drinks enough during the day, they should not be overly thirsty before bed. However, if they are thirsty, drinking a small amount before bed is okay.
Toileting twice before bed, about 20-30 minutes apart, insures an empty bladder to start the night off right.

I don’t think there is anything “wrong”. I frequently see this pattern of wetting, especially in children who have just begun using a bedwetting alarm. Since parents now know when the wetting is occurring, they are surprised and amazed that it occurs so early in the sleep cycle. In children with bedwetting, it seems that their bladder and pelvic floor muscles relax and let the urine flow out when their body relaxes and falls into deep sleep. Their bladder isn’t so full that it can’t hold any more urine; their body just lets the accumulated urine out at the wrong time. Two hours into the sleep cycle is when we are all very groggy, can’t make sense of where we are, and have very little memory of this sleep interruption. Parents observe a disoriented child, who may be combative or resistant, who do not remember the alarm at all in the morning.

When your son is ready to stop bedwetting, he will make great progress with a bedwetting alarm. Initially, the alarm will sound early in the sleep cycle, when he wets. Help him turn off the alarm and get up to the bathroom. He may not cooperate at all in the beginning (that will come later). Reattach the alarm because he may wet a second time later that night. Over the first few weeks, you will begin to see his pattern of wetting change. Instead of wetting in two hours, the wetting will happen later. His body will begin to learn that letting the urine flow out when in the deep sleep phase isn’t the best time to respond. He’ll begin to “hold it” longer and will respond more appropriately when the alarm sounds four to six hours into his sleep cycle. Eventually, he’ll get up before he wets or hold it until morning.

Continue to have him urinate twice before bed, about 30 minutes apart and limit evening fluids to water. Drinking a lot throughout the day will prevent him from being thirsty in the evening. Stopping disposable pants once he begins using a bedwetting alarm is a good time to transition to regular underwear in the nighttime. Using a waterproof mattress overlay on top of his sheet helps with clean-up.

There may be several factors at play here.  The extra sugar and tasty flavor may encourage him to drink more than he would if it was plain water.  In some children, the red and blue coloring agents cause the bladder to be more irritable and need to empty more urgently or frequently.  Also, chances are that his body is more fatigued on the nights that he has sports activities.  It may be more difficult for him to spontaneously wake up when he needs to go to the bathroom.

Sports are important and your son will eventually learn to stay dry every night, in spite of his evening activities or fluid intake.  Until that time comes, rehydrating with water or a clear sports drink is preferable.  Drinking before the practice or game will allow his body to process the fluids as the evening progresses.  If he feels thirsty, allow him to drink after his practices.  Encourage him to void twice before bed, about 20-30 minutes apart, so that he starts the night off with a completely empty bladder.  Being well rested is also helpful.  Having his homework done earlier in the evening should allow him to have a regular bedtime.

When you set an alarm clock, you are picking an arbitrary time to alert your son. His body doesn’t necessarily work on this schedule. Some nights he may not need to urinate at all, some nights it might be midnight and sometimes it may be 3:30. There is no way for you to predict precisely when his bladder needs to empty.

A bedwetting alarm, which senses moisture, is able to pinpoint when the wetting is occurring. It will alert your son exactly when his bladder needs to empty. Behavioral conditioning works to help him learn to wake up to the sound that occurs when the wetting happens. Over time, his body will be able to make the connection that a full bladder means get up and go to the bathroom.

Parents often ask, “Isn’t it too late to be alerted if the urine is already coming out?” In the beginning, the bladder may completely empty before the child or parent can respond. Over the first few weeks, however, the usual response is that the urine flow stops at the sound of the alarm. Instead of a large wet spot on the bed, the spot is reduced to a quarter sized spot on the underwear. Urine remains in the bladder and can be emptied in the toilet. Ultimately, the brain alerts the child to wake up before urination happens.

Making sure that the urine/urinary tract is normal is always prudent when noticing this behavior. You can consult with your pediatrician about this. Also, constipation and infrequent stools can contribute to daytime wetting problems. Address these factors first. If neither of these things is found to be contributory, you can move on to some behavioral techniques.

It seems that when these children’s bladders become overly full, they sent a very urgent message to the brain and begin contracting before the child has a chance to get to the bathroom. Parents describe this as “waiting until the last minute” or being so interested in play that they “ignore needing to go to the bathroom”. You and I receive messages from our bladder well in advance of actually needing to use the bathroom. We have time to finish what we’re doing and leisurely make our way to the toilet. Children with daytime wetting often don’t have this luxury.

We know that “timed voiding”, which is emptying the bladder on a schedule, rather than waiting for internal messages, is very effective in preventing overfull bladders from sending urgent messages. It’s almost impossible for a child, who has little comprehension of time, to remember to “Go to the bathroom every 2 hours”. A discreet, independent reminder can make all the difference.

Using a vibratory wristwatch is a great way of fostering the independent behavior of going to the bathroom on a regular schedule. Usually around every 2 hours is a good amount of time to begin with. For school age children, I prefer watches in which you can set specific times. That way, you can coordinate with the teacher the times that would be less disruptive but allow him/her to start p.e., recess or lunch with an empty bladder. Voiding at the end of the school day allows your child to begin the trip to home with an empty bladder, eliminating accidents on the bus or running to the bathroom when entering the house.

The Vibrowatch offers 12 independent times and vibrates about 20 seconds, making it difficult to ignore. The Medose and WobL watch each offer 6 independent alarms, and vibrate for 20 and 5 seconds, respectively. You can watch these videos to get a better idea of how these watches work. Most of my patients are amazed at how well their children do once they’re given a simple tool to help.

First of all, I don’t think that “weak bladder” is a description for any specific medical condition. Your grandson’s doctor may have used this as a generic term for an uncoordinated urinary system. The urinary system is quite complex, with several components innervated by different sets of nerves. In order to be completely dry during the day and night, quite a lot of coordination needs to take place. A good thing to know is that in the majority of children with nighttime wetting, the urinary system is completely normal. It’s the coordination of the different components that takes time and in some cases, some “nudging”, through the use of a timed voiding program or the use of bedwetting alarm in the nighttime. The actual bladder capacity (the amount the bladder holds before it perceives that it is full) varies from person to person and may necessitate your grandson getting up to use the bathroom in the nighttime or go a little more frequently in the daytime.

In the nighttime, children with bedwetting release the urine at a time when they are still asleep. The coordination between the brain and bladder hasn’t quite developed to the point where they “hold it” until morning or until a time when they can be more easily alerted. Bedwetting alarms work to alert the child and parents when the wetting is occurring. Over time, the sound helps the brain make the association between a full bladder and getting up to urinate. Bedwetting alarms harmlessly speed up this natural progression so that children can become dry over a few weeks or months rather than a few years.

Children with occasional daytime wetting often receive “urgent” messages from their overfull bladder. If there isn’t immediate access to a bathroom, the urine is released into their underwear. A successful strategy to help avoid this embarrassment is to empty the bladder on a regular basis, before it gets overfull. A vibratory wrist watch with programmed times (about every 2 hours) can be a helpful, discreet reminder to the child that they need to take a break and go to the bathroom. A watch also takes the parent or teacher out of the loop, so they don’t have to be the ones always doing the reminding. Of course, a child can choose to ignore the reminder, but in my experience, once a child is given the tools to make a change, most would gladly go to the bathroom than wet themselves.