Bedwetting, also known as nocturnal enuresis, refers to involuntary urination while asleep beyond the age of 5. While bedwetting can be frustrating for both parent and child, it’s often a regular part of a child’s development and not wilful or mischievous behaviour.
There are primarily two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been occurring since early childhood without any significant break. Secondary bedwetting begins after the child has been dry at night for a significant period of at least six months.
Causes of primary bedwetting
Here are some possible causes of primary bedwetting in children:
- An underdeveloped bladder that can hold less urine
- Unable to wake up when the bladder is full
- Inability to hold urine for the entire night
- Poor daytime toilet habits
- Having a family history of bedwetting
- Insufficient production of the hormone vasopressin, which limits the amount of urine that the body produces at night. Children who do not have enough vasopressin tend to produce large amounts of urine at night, increasing the likelihood of bedwetting.
Causes of secondary bedwetting
Secondary bedwetting could be an indication of an underlying medical or emotional issue. Secondary bedwetting is typically accompanied by other symptoms, such as daytime wetting. Here are some potential causes of secondary bedwetting in children:
- Urinary tract infections (UTI) can result in a frequent and urgent need to urinate. A UTI also causes inflammation and irritation of the bladder, which can exacerbate incontinence and bedwetting.
- Sleep apnea is a sleep disorder that causes disruptions in breathing. When sleep apnea disrupts the flow of oxygen into the body, the brain has to work harder to maintain safe oxygen levels, which places other functions like bladder control at the bottom of its priorities.
- Structural abnormalities in the organs, muscles or nerves involved in urination can result in incontinence and bedwetting.
- Diabetes results in increased urine output to get rid of excess sugar in the blood, leading to urinary frequency.
- Constipation can result in a bowel that’s overly full and constantly pressing on the bladder, reducing the amount of urine it can hold and resulting in urinary urgency.
- Neurological issues like abnormalities, injury or disease in the nervous system can affect bladder control.
- Emotional distress can cause bedwetting in children. Having parents in conflict or experiencing significant changes like starting school, moving to a new home or welcoming a new sibling are possible stressors that could result in bedwetting.
How to manage your child’s bedwetting
If your child is experiencing bedwetting, here are some tips to help your child manage:
- Increase fluid consumption earlier in the day and gradually reduce it later in the day.
- Avoid food and drinks that could irritate the bladder, such as those containing caffeine, excessive salt and artificial sugars and sweeteners.
- Establish a urination routine and encourage your child to visit the bathroom every two to three hours and right before bedtime.
- Stick to regular bedtime routines
- Be positive and encouraging. Never resort to punishment for bedwetting.
When to see a doctor for your child’s bedwetting
Bedwetting is usually not a concern, and most children outgrow bedwetting without any assistance. However, see a doctor if:
- Your child still wets the bed after age 7
- Your child suddenly starts wetting the bed after a few months of being dry at night (secondary bedwetting)
- Bedwetting is accompanied by other symptoms, such as an increased urge to urinate, painful urination, blood in urine etc.