Spilling the Truth About Bedwetting
Two of my three children wet the bed until they were 8 and 10 years old, respectively. In fact, I'm not putting my name on this story because my daughter and son would be mortified if their friends ever found out. My third was dry at night before he turned 3. It's hard to admit this, but I was so grateful for my Dry at Night Child and frustrated by my two Wet Ones. Especially on long family road trips, when we had to protect mattresses and wash pajamas in sinks. It hurt my heart to watch our kids worry about wetting.
Bedwetting affects more than 6 percent of all children in America, and about 15 percent of 5-year-olds wet the bed almost every night. (Research shows that bedwetting is around twice as common in boys, possibly because they tend to mature later than girls, both psychologically and physically.) And yet there's often no physical problem behind it. The urologist who examined my oldest child at age 7 said she was physiologically normal, which was comforting. I also appreciated his pointing out that while there were things we could try to help speed her ahead to dry nights, the most important goal was to preserve our daughter's self-esteem. What I learned about bedwetting will spare you the agony my family went through.
The biology of bedwetting
"Nocturnal enuresis" is the medical term for bedwetting that affects kids age 5 or older who wet the bed at least twice a week for at least three months. Genetics plays a role. "If one parent had nocturnal enuresis, then there's about a 40 percent chance that his or her child will have it," says Mark Posner, M.D., a urologist in Baton Rouge. Our kids got the bedwetting gene from both sides of the family: Both my husband and my grandmother wet the bed when they were young. But I was still puzzled, since my kids had been out of diapers during the day by age 3. It turns out that children who are dry all day but wet the bed at night may produce more urine at night than other kids, have a smaller bladder than their peers, and may be deep sleepers who have a lag time in communication between the brain and the bladder. It's often impossible to identify which combination of these factors is the culprit, Dr. Posner adds.
Constipation can be a cause too. If kids put off having bowel movements, stool can back up and the full bowels press on the bladder, says urologist Steve J. Hodges, M.D., author of It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and Other Potty Problems. He studied kids being treated for bedwetting and discovered via X-ray that all of them had excessive stool in their rectum; within three months of regularly taking the laxative Miralax, 80 percent had stopped wetting the bed.
Like many parents, I had to remind myself that my children's problem wasn't personal. Unless your child is especially oppositional or hostile, chances are high that he would prefer to be in a dry bed and he's not having accidents out of spite or laziness. Think about it: How must he feel waking up in cold, wet sheets and then seeing his parents' look of irritated disappointment? And what about the embarrassment of soaking yourself at a slumber party? This is why experts caution against any kind of discipline for bedwetting. "It can truly be harmful to your child's self-esteem," says Sacramento pediatrician Melissa Arca, M.D.
To help preserve a kid's self-image, Dr. Posner makes a point of asking parents -- in front of the child -- whether there were other bedwetters in the family. "It's reassuring when a child learns that other people, including relatives, have had the same problem. I point out that some of their friends may very well wet the bed too," he says.
My children used daytime Pull-Ups successfully at night until they were about 5, but after that, they often soaked through them. I moved my daughter up to diapers for adults, but sometimes even those leaked. What worked was double-sheeting the bed. You might try this process:
- Put a sheet over a waterproof mattress protector (or even a shower-curtain liner), put another mattress protector on top of it, and another sheet on that. If your child wets, he can remove the top sheet and protector, and have a dry sheet and protected mattress waiting. Keep an extra blanket and dry pajamas nearby, and your child may not even need to wake you up!
- To remove the urine odor from bedding and pj's, I swore by a capful of white vinegar and a sprinkle of baking soda with detergent in the wash water.
Bedwetting: Your game plan
Most children eventually stop wetting on their own, but it's frustrating not to know when that magical "Wake Up Dry" date will be. For kids 6 and older who are clearly bothered by wetting, Dr. Arca recommends an alarm that has a wetness sensor that attaches inside underwear and rings loudly -- or vibrates powerfully, for more privacy -- at the first drop, so the child can try to make it to the bathroom in time. "It typically takes about 12 weeks for the brain and bladder to be trained to communicate, so you'll need to be patient," says Dr. Arca. But the key to success is a child who truly wants to stay dry. When that's not the case, she suggests parents simply wait it out.
Certain strategies -- such as using waterproof mattress covers and big-kid disposable undergarments such as UnderJams or GoodNites -- can minimize the trauma of bedwetting. Although encouraging your child to help you strip the bed is fine, it's important to make it feel like a team effort and not an exercise in shame.
It seems logical to limit how much your child drinks in order to decrease the chance of his wetting the bed, though there's not much scientific data to back this up. Dr. Posner has seen in his own practice that it can be helpful, so he suggests patients reduce fluid intake after 7 p.m.
You can also wake your child to use the bathroom before you go to bed, and then again in the middle of the night, suggests Dr. Arca. But stop if that doesn't improve things right away. With some children, disturbing their sleep can actually make bedwetting worse.
If your child ever has trouble with her bowel movements, mention it to your doctor. Because of the proven link between bedwetting and constipation, she may want to X-ray your child to see whether she has a backup of stool (a condition called 'megarectum'). If she does, she may need enema therapy along with a mild laxative like Miralax to help remove the stool and restore the condition of the rectal wall, says Dr. Hodges, associate professor of urology at Wake Forest Medical Center in Winston-Salem, North Carolina. ("Imagine a stretched-out T-shirt," he says of the effects of megarectum.)
If alarms and other prevention methods don't work, you may consider prescription medications that can help treat (not cure) bedwetting. A hormone drug called desmopressin decreases the amount of urine produced at night. Used daily in kids as young as 6, it comes in a small tablet; rare side effects include nausea and vomiting. It may take some time to find the dosage that works best for your child, so start it well in advance for occasions like weekend trips or sleepover camp. It works between 12 and 40 percent of the time. After your child has had three months of success, she stops taking it and you determine whether bedwetting is gone for good.
Other drugs, including oxybutynin and imipramine, work by relaxing the bladder so that it can hold more urine overnight. Doctors consider them for kids 5 and older only when all other therapeutic options have failed. Both drugs are usually taken daily for six months or more. Oxybutynin is used most often in kids who have bladder-control problems when they're awake as well as asleep; it's less effective in kids who wet at night only. It comes in a liquid or tablet form and helps reduce contractions in the bladder. The tricyclic antidepressant imipramine is available in tablets, and low doses have shown to cure enuresis in 25 to 50 percent of cases. Rates of bedwetting after stopping it, however, can be as high as 50 percent. Side effects are uncommon but can include sleep problems, upset stomach, and nervousness.
No one solution helped my children stop wetting. My daughter quit the bed alarm after one failed attempt; she never recalled hearing it. Waking her to urinate didn't help, and she never tried medicine. However, neither my son nor my daughter seemed ashamed of wetting at the time; we assured them that everyone's body is different and one day they would be ready to stop wetting the bed. Sure enough, almost magically, one day they were. And their beds have been dry and cozy ever since.
Originally published in the March 2013 issue of Parents magazine.
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