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. It takes some children slightly longer to establish a routine.

If children over the age of five regularly wet the bed with no physical cause, this is referred to as bedwetting or “nocturnal enuresis”.

It can be distressing for the family when a child is not getting through the night dry, especially when it happens frequently.

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 child must also develop control of the bladder’s sphincter muscle.
• The body produces sufficient antidiuretic hormone (ADH), also known as 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.

A little over 15 percent of all children are affected by bedwetting at the age of five. The prevalence declines with age.

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

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

If a child has been dry for more than six months and then starts wetting the bed again, this is known as secondary bedwetting and can be a sign 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.

However, secondary bedwetting can also have physical causes, such as a kidney or bladder infection or diabetes.

Doctors establish a diagnosis of “bedwetting” when a child over the age of five wets the 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, kidney disease, the 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 urinating, for example starting or ending 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 the bladder is empty afterwards

It’s a good idea to monitor and note the following for a while:

• what and how often the child eats and drinks
• when and how often the child urinates

In many cases, it is also useful to measure the urine output. Doctors can provide advice on the best way to do this and what should be noted when keeping a “bladder diary”.

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

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 and foremost, the most important thing is to stop the child from worrying. It is important to make it clear that the 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.

Electronic alarm systems such as alarmed underwear or mats can help keep children dry. An alarm is triggered as soon as the first few drops are detected and this wakes the child up in time. However, such alarm systems do not work for all children as some of them sleep too deeply.

Another option is to “dream pee” the child, i.e. to briefly wake them and get them to go to the toilet during the night.

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

It can help for parents and children to know that bedwetting is not unusual and is highly likely to resolve itself naturally.

During everyday life, it can help to optimally prepare for night-time “accidents”:

• The child’s mattress can be protected with a rubber mat or protector.
• 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.

For further information on making everyday life with bedwetting easier, please visit gesundheitsinformation.de.