One of the first steps toward effective treatment for bedwetting is understanding the problem. There are a lot of misconceptions surrounding nighttime wetting, including:
Myth: Children who wet the bed are lazy or have emotional problems. Fact: Nighttime wetting can be caused by medical or developmental issues and is not uncommon in young children.
Myth: Children wet the bed because they drink too much liquid before bedtime. Fact: The body produces urine throughout the night, regardless of how much liquid a child consumes before bed. Limiting fluids can increase the risk of dehydration.
Myth: Children wet the bed because they have small bladders. Fact: Children and adults of all ages experience bedwetting. Developing the ability to wake up in spite of a small bladder capacity is what keeps people dry at night.
Myth: Medication is the best bedwetting treatment. Fact: Studies show that bedwetting alarms are more effective than drug therapy for nighttime wetting. The positive effects of drug therapy tend to stop once medication is discontinued, while the ability to recognize bladder fullness as a result of alarm-training persists.
Myth: You have to wait for your child to outgrow bedwetting. Fact: Because we now have safe, effective techniques to help children eliminate bedwetting, there is no reason that you have to wait years for bedwetting to stop spontaneously.
Myth: Bedwetting occurs because children are left in disposable pants too long. Fact: Using disposable pants can decrease parent frustration until treatment is started.
Why Bedwetting Happens
There are a few reasons that a child can have bedwetting. More than one of these factors can play a role in your child’s bedwetting.
Heredity – Bedwetting runs in families. The bedwetting gene can be passed along.
High Urine Production – It is believed that some children with bedwetting produce more nighttime urine that their peers.
Small Functional Bladder Capacity – When a child’s bladder capacity is low, they are less able to hold a normal amount of urine at night.
Sleep or Arousal Disorder – It is generally accepted that children are not easily aroused from sleep and are often disoriented when awakened.
Irregular bowel movements or constipation – When the bowel is full, the bladder’s expansion may be restricted or result in decreased sensitivity to bladder fullness.
Food Sensitivities – Citrus, caffeine, carbonated drinks and other foods may contribute to bedwetting.
How Common is Bedwetting
The development of urinary control is a maturational process. Everyone is born wetting the bed. As children grow and develop, so does their ability to control their bladder.
Between the ages of 1 and 2, they have a gradual enlargement of bladder capacity and begin to sense when their bladder is full.
When they are 3 and 4, they learn to void, or inhibit voiding, voluntarily.
By the age of 5, the majority of children have an adult pattern of urinary control and the maturation of the bladder is complete.
However, about 20% of children have not developed this pattern and are still having bedwetting episodes. As your bedwetting child grows older, chances increase that intervention will stop the nighttime wetting in a few weeks rather than waiting years for bedwetting to just disappear.
Medical Causes of Bed Wetting
Although only 3% of children who wet the bed have a medical reason for doing so, it's important to make sure medical problems aren't contributing to the wet nights. If your child develops a bedwetting problem, talk to her healthcare provider. Here are some of the more common medical causes of bedwetting:
Bladder or urinary abnormality
Before visiting your healthcare provider, keep a diary of your child's wetting problem for a week or so. Ask yourself the following questions:
When did the problem start?
Has it improved or worsened since its onset?
How frequently do nighttime accidents occur?
If you're using protective undergarments, which types have been effective? These can act as a kind of gauge of urine volume, so keep track of any products you've used.
Does your child tend to be a heavy sleeper?
Also keep track of any environmental factors that you think could be relevant. The more information you can provide your healthcare provider with, the more comprehensive the treatment plan will be.
Do's and Don’ts of Nighttime Wetting
If your child struggles with bedwetting, here are some do's and don'ts for approaching the situation:
Don't worry—with the right treatment, most children overcome nighttime wetting.
Don't punish your child for wetting. Bedwetting is not something your child has control over, therefore punishment will not be effective in making it go away more quickly.
Don't compare your child to other kids—every child develops at her own pace.
Don't restrict your child's fluids. If your child is thirsty, stick with water, as kids tend not to over-drink it. Stay away from sugary drinks, as kids sometimes drink too much of them because of their taste. Milk should also be avoided, as it can cause sleepiness.
Do visit your child’s healthcare provider to rule out medical issues.
Do make efforts to boost your child’s self-esteem. Make sure she knows that she's not alone and help save her embarrassment by arming her with the right protective tools.
Do set goals with your child about bedwetting treatment and alarm use. Focus on successes and downplay accidents.
Do pay close attention to your child's progress and alter your treatment plan as needed. For example, if she has trouble waking up to an audible alarm, try one that also uses vibration.
Common Bedwetting Treatments: Are They Effective?
There are many steps that you can take to stop your child's bedwetting problem. Here's a list of some common methods of eliminating bedwetting, some of which are effective and some that should be avoided:
Restricting fluids: This is only effective for about 15% of bedwetting children, since fluid consumption is usually not the cause of the problem. You also run the risk of dehydrating your child. A better way to maintain adequate hydration is to move overall fluid intake to earlier in the day.
Waking child or setting alarm clock: This is according to the parent’s schedule and does little to help your child develop the ability to wake up to a full bladder.
Punishment: Bedwetting is something that your child doesn't have control over. Punishing her will most likely lead to poor self-esteem, increased anxiety, and a subsequent continuation of the problem.
Drug therapy: DDAVP is a synthetic version of vasopressin (a natural hormone) and is administered as a small pill. DDAVP decreases the amount of urine produced at night and stops wetting in about half of the children who take it. The dosage varies between 1-3 tablets per night. Oxybutinin (Ditropan) is a medication used to treat overactive bladder. This can be helpful in children who experience urgency or frequency in the daytime as well as nighttime wetting. While medications may provide a temporary solution to bedwetting, most children begin wetting once they stop taking them.
Bedwetting alarms: Because these devices train your child to recognize a full bladder, their effects will last long after treatment. The alarms' success rate is higher and relapse rate lower than any other type of therapy. Choose from wearable alarms, pad-type alarms, and wireless alarm kits.
Help Your Child Get Control
While bedwetting is common among children, many assume that bedwetting indicates that they're not growing up properly or quickly enough. Children who are old enough will benefit from taking parts of their bedwetting treatment into their own hands.
Many children who wet the bed feel out of control of their situation, and this often leads to lowered self-esteem. Involve your child in his own treatment by allowing him to make as many decisions as possible. For example, what type and color of bedwetting alarm would he prefer? What protective bedding and undergarments does he think will be most comfortable?
One of the advantages of bedwetting alarm treatment is that, after the first couple of weeks of the parent responding to the alarm and waking the child up, the child should then be better able to recognize the sound of the alarm and the feeling of bladder fullness. When you think he's ready, encourage him to get up on his own to use the bathroom at the sound of the alarm.
It also helps to show your child how to take care of the bed in case of nighttime accidents. Have him help you remove any soiled protective bedding and reapply new, clean protection one night after an accident. Do this a few times, then encourage him to do it on his own in the future. Make it easy for him by always making sure that there are plenty of replacement underpads, overlays, and towels near the bed.