Bed-wetting refers to the involuntary urination which occurs during sleep and especially at night. Bedwetting can have multiple causes in children. However, treatments exist to allow the child to control his or her sphincters.

Bedwetting affects approximately 10% of children between the age of 5 to 10 and more often boys than girls. Enuresis — the medical name of bed-wetting — is the active, complete, unconscious and involuntary urination, occurring during sleep, most of the time during the night. We can only talk of enuresis from the age 5, because it is at this age that physiological control of the bladder sphincter (of the bladder therefore) is acquired.

There are two types of bedwetting

Bedwetting is said to be primary when the condition has been ongoing since birth. It occurs in 10% to 15% of children between the age of five and eight and in 6% to 8% of those aged eight or more.

Bedwetting is secondary if it follows a period of complete inoccurence of at least 6 months. In secondary bed-wetting, it is useful to perform a checkup in search of a urinary tract infection or intestinal parasitosis.

Isolated nocturnal bed-wetting represents the majority of cases, but bedwetting during the day, and bedwetting both at night and during the day can also occur.

We distinguish

  • Total enuresis: the child urinates every night;
  • Sparse Enuresis: happens usually after the age of 8 where we find a correlation between humid nights and events of the previous day;
  • Intermittent enuresis: accidents only occur at certain periods;
  • Episodic enuresis: accidents occur exceptionally during illnesses, separations, important family events etc.

We do not talk about enuresis when it comes to polyuria (abundant urine in the case of various pathologies: diabetes, nephropathies, etc.), abnormal urination (urinary incontinence) by chronic retention of urine or ureteral anomalies, loss of urine during an epilepsy attack. This term also does not concern the delay in acquiring sphincter control in people with motor or mental deficiencies.

Causes of primary bedwetting

  • Heredity: Family factors are possible. A child whose parent is enuretic is almost 30% likely to be enuretic and the risk reaches 70% when both parents have had this problem.
  • Immaturity of the bladder: In the case of primary enuresis, the immaturity of the bladder is often responsible. We speak of bladder immaturity when there is a delay in the neuromuscular reflexes controlling the bladder.
  • Antidiuretic hormone disorder: the antidiuretic hormone which is responsible for the production of urine, can also the cause.
  • Small bladder: The child may also have a small bladder capacity or a particularly high arousal threshold, that is to say that the child remains asleep despite the warning signals from the bladder.
  • Lack of training: The cause may also be an incomplete toilet training, or drinking too much before bedtime.

Causes of secondary bed-wetting

  • Urinary track infection: in secondary enuresis, a urinary tract infection can cause bedwetting
  • Type 1 diabetes if associated with polyuria (excessive urination) can also cause bed-wetting
  • Psychological factors intervenes mainly in the case of secondary bedwetting, but is less frequent than we think. It is often important changes in the child’s life that are responsible: birth of another child, departure of a loved one, illness in the family, problems at school…

Symptoms of bed-wetting

In the event of primary or secondary enuresis, the child wets his bed, either every night or occasionally:

  • In the case of bladder immaturity, the child presents a very urgent desire to urinate with great difficulty in retaining the urine, an increase in the frequency of urination, and sometimes urinary leakage;
  • In the case of a urinary tract infection, the child suffers from a burning or burning sensation while urinating. Sometimes accompanied by fever, urinary tract infection increases the frequency of urination during the day. In addition, the urine is cloudy or very odorous;
  • In children with diabetes, urination is very common, and the child gets thirsty very often. Weight loss and significant fatigue are often associated;
  • bed-wetting linked to uropathy causes difficulty in urinating, the child is often forced to push to evacuate the urine.

Treatment of bed-wetting

Bedwetting always heals sooner or later, but the older the bedwetting, the more difficult the treatment. Current treatments are based on drugs and especially on medical and/or psychological care of the child.

Educational and hygienic measures

Parents should keep in mind that the child does not intentionally wet the bed. Thus, it is essential to restore his or her confidence, not to make him or her feel guilty, or to humiliate him or her. Punishing your child has no benefits in a bedwetting problem and could even make the situation worse. A few simple tips can help the child solve this little problem:

  • Encourage the child to go to the bathroom regularly during the day;
  • Teach the child to listen to signals from the bladder;
  • Prevent the child from retaining his or her urine
  • Prevent the child from drinking too much before bedtime;
  • Install a night light so that the child can go to the bathroom at night without difficulty;
  • Talk with your child to make him or her feel less guilty, using educational books if necessary.

Drug treatments

Drug treatment of bedwetting is not systematic. The care is based first of all on educational and hygienic measures (in particular concerning the distribution of drinks during the day, with less liquids as bedtime approaches). In case of failure, drug or behavioral treatment (alarm system) can be undertaken, but not before the age of 6 years.

For drug treatments desmopressin (MINIRIN) in tablet form is authorized in the treatment of bed-wetting associated with nocturnal polyuria and refractory to hygienic-dietary measures as well as certain antidepressants (but these are controversial because of their secondary effects).

The doctor will give the child simple and appropriate anatomical and physiological information in order to demystify the symptom and make him or her understand that he or she can heal. A fun self-monitoring book can be given to the child so that he or she can record the dry or wet episodes of his or her nights every morning during the 3 months of treatment.

The psychological care of the child

In talking with the child, the doctor will know if he or she is indifferent to his or she symptom, or rather uncomfortable.

The pediatrician must first convince the parents not to intervene. They must play on indifference: do not make any comments on the symptom, do not make fun of it, do not punish or reward the child in any case… Neither should the parents show wet sheets to neighbors or friends or force the child to wash his or her wet clothes him- or herself. Parents should also avoid treating the child like an infant. In a word, it is imperative to leave the child alone!

If necessary, follow-up with a child psychiatrist or psychologist allows the child to be involved in his or her treatment. The specialist uses games and drawings to make it easier for the child to express his or her feelings. Little by little, the psychologist will give advice to the child and the parents to treat bedwetting as a whole.

An alarm system

The “pee stop” is an electrical device that triggers a ring as soon as the first drops of urine are emitted. Concretely, a diaper is placed in the child’s underwear and is connected to the device. When the sleeping child begins urination, the sensor detects humidity and the buzzer sounds. The child, completely awake, can then go to the toilet to finish urinating. This solution can be hard on the child since he or she sometimes has to wake up several times during the night to urinate.

On the same subject: Bed-Wetting Children Sleep Less Efficiently

Cassidy Perry

A certified dietician specializing in diabetes care, Cassidy has over a decade of experience working with diverse patient backgrounds. She writes health-related articles for the Scientific Origin.