Fact sheet: Bed-wetting in children and teenagers

It is not unusual for children and even teenagers to wet the bed sometimes. From about the age of five, most children sleep through the night or wake up if their bladder is full. But more children than you might think only reach this stage of development later: about one in six five-year-old children occasionally notice too late that their bladder is full. When they wake up they have already wet the bed.

Occasional bed-wetting is not uncommon in five-year-olds. It only becomes a problem if it puts a serious strain on the child or the family. The medical term for a bed-wetting problem is nocturnal enuresis. Many children only wet the bed once or twice a month, whereas others do so more than twice a week. The problem almost always goes away on its own after a while, and there are a number of things that parents can do to help their child.

What are the causes of bed-wetting?

The main cause of bed-wetting in children and teenagers is failing to wake up when their bladder is full. They do not do it on purpose. Their bladder control is simply not completely developed yet and they are not aware that it is time to get up and go to the toilet.

There is reason to believe that the time when children stop wetting the bed also depends on their genes. Comparisons between families have shown that more than half of children who wet the bed also have relatives who had a problem with bed-wetting.

Bed-wetting can also have medical causes, such as producing too much urine during the night. It can be a sign of a kidney or bladder infection or another health problem, especially when a child begins to wet the bed again at night after being “dry” for a while.

Certain factors can make bed-wetting more likely in children. These include digestive problems and having caffeinated drinks shortly before going to bed. Sometimes stress and worrying can also trigger bed-wetting.

 

Researchers have long been interested in the role of psychological factors in bed-wetting. A number of studies have found that, compared to “dry” children, those who wet the bed also tend to have more worries or emotional problems. But it is not clear which comes first – in other words, whether children who have emotional problems are more likely to wet the bed, or whether children who wet the bed are more likely to develop emotional problems, for instance because they are ashamed.

What can help my child to stop wetting the bed?

There is no shortage of products and advice for people who have this problem. But only a few methods have been proven to help. Research on electronic waking devices, such as bed-wetting alarms in special bed pads or attached to the child’s underwear, has shown them to be the most helpful methods in the long term. These systems detect wetness and then set off an alarm that is supposed to wake the child up. They usually have to be used for several months, so patience and motivation are needed. The nightly alarm has to be accepted by the whole family. But the effort can pay off, especially if the child is very upset about wetting the bed: more than 40 out of 100 children who use alarm systems are “dry” within a few weeks or months. Without this alarm system, only 1 out of 100 children stop wetting the bed in the same space of time.

Medication has a lower rate of success than alarm systems and is not very suitable for younger children. It starts working very quickly, but the effect usually wears off as soon as you stop taking it. So medication is not a long-term solution to bed-wetting. However, it can be helpful in situations where a child has to be dry for a limited period of time – for instance, if he or she is away from home for a few nights.

The medications that have been proven to work are the hormone-like drug desmopressin and drugs belonging to the group of tricyclic antidepressants. Both are taken as tablets. Desmopressin works in about 20 out of 100 children. It can have adverse effects like headaches and nausea, which affect about 5 out of 100 children but are usually mild. To avoid adverse effects, children and teenagers should not drink more than 250 milliliters (8.5 ounces) of liquid in the evening when they are taking desmopressin.

One tricyclic antidepressant that has been quite well studied as a treatment for bed-wetting is imipramine. It also works in about 20 out of 100 children, but has more frequent adverse effects than desmopressin, including low blood pressure, dry mouth, sweating, nausea and tiredness. There are different opinions about which antidepressants are safe to use for children and teenagers.

What can help parents and children in everyday life?

It can already be helpful for parents and children to know that bed-wetting is nothing unusual and that many families are affected by it. Practical measures include covering the mattress with a rubber mat or special cover and have fresh bed linen at hand. That will make it easier for everyone to manage and go back to sleep quicker when an accident happens.

To stop a urine smell from developing, it is important that the child showers in the morning and wears fresh clothes. This will help to avoid reactions of rejection or disgust among friends and at school. To get rid of the smell of urine in bed linen and clothes, soda and/or eucalyptus oil can be used in the wash, for example.

It is very important to be there for the child and not punish or shout at him or her. Make it clear that bed-wetting is very common and that a lot of families have this problem. It is very likely that the problem will eventually go away by itself.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)