Bedwetting Tips From a Urologist and Mom

Contrary to what many parents think staying dry overnight is not the same at all as daytime dryness. Most kids can learn to be potty trained during the day way before they become dry overnight. I have invited an amazing guest blogger who is a mom and physician specializing in urology to explain bedwetting , the myths, the facts and what can be done while waiting patiently for most kids to stop bedwetting. Also keep reading to find out why fluid restriction and waking kids up at night to pee isn’t really an effective long term treatment for bedwetting.

Bedwetting Tips from a Urologist

Bedwetting is exhausting and anxiety provoking for both the child and the parents. As a Urologist, I experienced this firsthand, when my older daughter did not have a dry night at 5 years old. I found myself reassessing and rereading everything that I learned about bedwetting, trying to find comfort in intellectualizing the issue.  Below are answers to the most common questions surrounding this issue.

(1)  Will my child ever become dry?

Bear in mind, bedwetting is common. As many as 5-10% of 7-year-olds and even 0.5%-1% of adults still wet their beds.[i] Under the age of 5, consider it a part of potty training. The vast majority of kids WILL eventually “grow out of it.”  Even so, it may result in self-esteem issues for the child. It is important to realize that they are not “being lazy” and avoid shaming tactics.

(2)  When do we need to seek treatment for bedwetting?

While these children appear to be sleeping deeply, they may actually have chronically disturbed sleep, leading to behavioral problems.[ii] In the absence of “red flags” (see #3), you should seek help when it bothers the child. This usually occurs around 6, when they start going to camp or having sleepovers. However, if there is psychological distress occurring at a younger age, then treatment can be initiated earlier. Likewise, if the child is not bothered, this can be delayed.

(3)  What are the kinds of treatment options can I expect?

In most cases, treatment for bedwetting starts with the least invasive option and escalates to the most invasive. However, the order may vary depending on the individual nature of your child’s issues.

- Behavioral Therapy: For the motivated, light sleeper, without a family history of bedwetting, a plan of active encouragement may be effective alone in at least 15% of children.[iii] In this therapy, the function of the bladder is demystified to the child and family. The family is provided a program for optimizing voiding behavior, including instructions for regular bowel movements. Most importantly, the child needs to void in a timely, relaxed, pressure free environment. A bedwetting chart or calendar with small rewards for dry nights and bigger rewards for multiple dry nights may be quite helpful.

- Bedwetting alarm: This is a device that provides a loud arousal stimulus the moment urine is sensed. This helps to establish the mind-body connection that wakes the child up when they are about to wet the bed. In the motivated child and family, success rates can be as high as 50-70%. Importantly, when success is achieved, this tends to be curative.[iv] In order to achieve success, the child must be awoken immediately when the sound is heard. A sensitive alarm as well as high parental participation is necessary. Check-ins with your physician at 1-3 weeks is helpful to work out any technical issues. Progress is made when there has been an increased number of dry nights or smaller wet spots. This should be continued until there has been 14 consecutive dry nights. If there is no progress after 6 months, this therapy should be discontinued.[v]

- Desmopression: This is a medication that decreases urine production. As a general rule of thumb, ⅓ of children will become dry, ⅓ will see no benefit and ⅓ will have some response.[vi] Avoid taking this medication with heavy fluid intake to prevent serious side-effects. This may be a good strategy for short-term goals, such as a sleep-over or overnight camp.

- Other medications: Antidepressants and other medications that may relax the bladder also have a role when the above fail.

- Despite these therapy options, there will still be some children who will remain wet. These should be evaluated by a pediatric urologist.

(4)  What are the warning signs that may indicate a medical issue?

If any of these are happening, you should seek help immediately.

- Weight loss, growth that has fallen off the charts and/or nausea.

- Voiding difficulties: Does your child strain when he/she voids? Does he/she perform holding maneuvers? Does his/her stream seem weak?

- Constipation: Does your child have fewer than 2 bowel movements per week? Are the bowel movements hard or painful? Has your child ever had episodes where he/she has lost control of stool?

- Heavy snoring.

- Daytime incontinence: Does your child have issues with loss or dribbling of urine even in the daytime?

- Urgency: Does your child have a sudden, unexpected urge to void that is difficult to suppress?

- Unusually low (fewer than 4 times a day) or high (more than 7 times per day) amounts.

(5)  What are common pitfalls to avoid?

The moment you start “googling” about bedwetting, you will encounter many well-meaning, but ineffective strategies. Here are the common ones.

- Fluid restriction: Common advice is to give the child a lot of water during the day, to avoid dehydration in the evenings. While this is not bad advice, there is not a lot of data to support this in the absence of high nighttime urine production (nocturnal polyuria). Restricting a child’s fluid intake may allow him/her to produce less urine at night, however, many times, bedwetting is an arousal issue rather than a production issue. You may find that the child will have an accident even in the absence of a full bladder. This strategy may be used as an adjunct to medication therapy to avoid side effects.

- Waking the child up regularly: Unfortunately, this is frustrating and exhausting for both the child and the parents. It is also ineffective. While it may help keep the child’s bladder empty, it does not help develop the child’s own arousal mechanism.

Dr. Jessica Lubahn, MD is a medical doctor and urologist. She is a health writer and consultant and is the creator of ONDRwear (ondrwear.com) which are leakproof underwear with a plant-based liner for preventing leaks. 

[i] Bower WF, Moore KH, Shepherd RB, et al (1996). The epidemiology of childhood enuresis in Australia. Br J Urol 78(4):602-6.

[ii] Van Herzeele C, Dhondt K, Roels SP, et al (2016). Desmopression (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol 31(9):1477-84.

[iii] Von Gontard A, Kuwertz-Broking E (2019) The Diagnosis and Treatment of Enuresis and Functional Daytime Urinary Incontinence. Dtsch Arztebl Int 116:279-85.

[iv] Kosilov KV, Geltser BI, Loparev SA, et al (2018). The optimal duration of alarm therapy use in children with primary monosymptomatic nocturnal enuresis.

[v] Neveus T, Fonseca E, Franco I, et al (2019). Management and treatment of nocturnal enuresis- an update standardization document from the International Children’s Continence Society. J Ped Urol 16:10-19.

[vi] Glazener CM, Evans JH. (2002). Desmopression for nocturnal enuresis. Cochrane Database Syst Rev 3:CD002112.