Bedwetting

It is not unusual for children and even adolescents to occasionally wet the bed. Most children from the age of five normally sleep through or wake up when they need to go to the bathroom. Sometimes it takes longer for a child to stay completely dry.

At a glance

  • Many children, but sometimes also adolescents, experience bedwetting.
  • Most children are dry from the age of about five.
  • There are various ways of helping the child and to improve the situation.
  • When children and adolescents wet the bed, it is usually because they are not waking up when their bladder is full.
  • The age at which a child starts to get through the night dry is believed to be partly determined by genes.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Nocturnal enuresis: a large stain apparently caused by a liquid, clearly urine in the middle of a white bedsheet laid over a mattress.

What is bedwetting?

Many children and sometimes also adolescents wet the bed from time to time. But it is rarely spoken about.

Children from the age of about five normally sleep through the night or wake up when they need to go to the bathroom. For some it takes a bit longer for them to establish a routine: more than 15 percent of children aged five years notice too late that their bladder is full and wake up in a bed that is already wet.

When children above five years of age keep wetting the bed with no physical cause, this is referred to as bedwetting (“nocturnal enuresis”). It can be distressing for the family when a child is not getting through the night dry, especially when it happens frequently.

What causes bedwetting in children and adolescents?

Children and adolescents usually experience bedwetting when the bladder is full but they don’t wake up in time. The urethral sphincter then relaxes and the bladder empties itself while they are sleeping. This is not intentional – the child has no control over their bladder because it is still maturing.

The following developments must have taken place for a child to stay dry at night:

  • The brain recognizes and processes the bladder’s nerve signals so that the child is awake when the bladder is full. The brain has also learned to control the bladder’s sphincter muscle.
  • Their body produces sufficient antidiuretic hormone (ADH or vasopressin) at night. This means that the kidneys produce less urine during the night.
  • The bladder is big enough to store urine produced in the night.

Apparently their genetic make-up also determines when a child starts to stay dry at night, as evidenced by studies and comparisons of different families. They show that bedwetting children are not usually the only ones in the family who have this problem.

How often do children wet the bed?

While many children only wet the bed once or twice a month, some do so several times in the week.

How common is nocturnal enuresis? Bar chart showing how many children are still affected by nocturnal enuresis, by age. A little over 10% of all children are affected by nocturnal enuresis at the age of 5. The incidence declines with age.

Boys are more often affected than girls. The problem usually goes away by itself after a while.

Nocturnal enuresis: adult lying on their side in a bed There is a dark patch on the seat of the trousers. There is a darker patch on the bedsheet at the level of the buttocks. The person has clearly wet themselves and the bed.

How can bedwetting develop?

If a child has been dry for more than six months and wets the bed again (“secondary enuresis”), this indicates psychological stress.

If a child has been dry for more than six months and then starts wetting the bed again this is an indication of psychological stress.

The triggers for this can be problems within the family or changes in the family such as the birth of another child. But secondary bedwetting can also have physical causes such as a kidney or bladder infection or diabetes.

How is bedwetting diagnosed?

Doctors diagnose “bedwetting” when a child above five years of age wets their bed more than once a week for at least three months. 

The child may have another condition that is causing the bedwetting but this is very rare. The possible causes are urinary tract infections, urinary tract disorders, onset of diabetes mellitus or an overactive thyroid. Children can also lose control of their bladder as a result of pauses in their breathing during sleep (“sleep apnea”)

The doctor is able to rule out these causes by having an in-depth conversation with the child and their parents and then performing a physical examination, during which they look for evidence of other possible conditions – e.g. that the child: 

  • also wets themselves or “dribbles” during the day
  • has problems peeing, for example starting or ending it without interruptions to the flow
  • has pain when peeing
  • pees very rarely (less than three times a day) or very often (more than eight times a day)
  • has a weak urine stream
  • does not feel that their bladder is emptied afterwards

It’s a good idea to spend some time observing and writing down what and how much the child is eating and drinking and when and how often they are peeing.

A rapid urine test can rule out a urinary tract infection or diabetes. Additional tests are only performed where there is concrete evidence that the bedwetting might be caused by a specific condition.

How is bedwetting treated?

There is a lot of advice about what can be done do to stop bedwetting but a lot of it has been proven to be less than helpful. First of all, the most important thing is to take the child’s worries away. It is important to make it clear to them that their bedwetting is not their “fault”.

One can try giving the child only a little to drink from two hours before bedtime and during the night and, in any case, avoid drinks containing caffeine and sugar such as lemonade or coke. If the child tends to suffer from constipation, giving them a diet rich in fiber will help to improve this.

Electronic alarm systems such as panties or pads with an alarm system attached to them have been shown to be helpful. An alarm is triggered as soon as the first few drops are detected and this wakes the child up in time.

Important: Medication is generally not recommended for children under the age of seven. The active substance desmopressin is typically used with older children as it is similar to the body’s own antidiuretic hormone vasopressin. Medication acts very quickly but only for as long as they are taken. It can be of temporary help, for example when the child is sleeping away from home. This medication can be used even when children sleep very deeply and the alarm systems don’t work.

More detailed information on the subject and on how bedwetting can be treated can be found at gesundheitsinformation.de.

How do you deal with bedwetting?

It can help for parents and children to know that bedwetting is nothing unusual and is highly likely to resolve again by itself.

It makes things easier to have a daily routine of preparing for night-time “accidents” as much as possible – the child’s mattress can be protected by rubber mats or covers. Clean bedding can be laid out ready to save time in the night. Diapers or diaper pants are also an option.

The child will not smell of urine if they shower and put on clean clothes each morning. This will mean that they won’t be teased at school. Using washing soda (sodium bicarbonate) or eucalyptus oil helps to get rid of the smell of urine in the bedding and clothes.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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