Bedwetting In Children: What Is Bedwetting, Causes, Symptoms And Treatment

What is bedwetting?

Enuresis or bedwetting is common among young children. It is the unintentional or involuntary passing of urine by a child when asleep. Even toilet-trained children who use the toilet to relieve themselves when awake are prone to wetting the bed while asleep.

Nocturnal enuresis is more common in toddlers and preschoolers, but most children outgrow it by the time they are five to six years old. However, some children continue to wet the bed until they are ten to twelve years old.

Types of bedwetting

Enuresis is of two types:

1. Primary enuresis: This type of enuresis affects 80 per cent of children who wet the bed.
2. Secondary enuresis: Twenty per cent of children who wet the bed have secondary enuresis.

What causes a child to wet the bed?

There are quite a few causes for bedwetting in children. The common among them are:

• Small bladder because of which a child cannot store urine for the entire night
• Inability to sense the bladder is full and wake up to go to the toilet
• Family history of bedwetting

Some medical conditions like urinary tract infection and neurological problems can also cause enuresis.

What causes primary bedwetting?

A child is said to have primary enuresis when he has not achieved night-time bladder control. Some causes of primary enuresis include poor toilet habits, inability to wake up when the bladder is full and genetic factors.

What causes secondary bedwetting?

A child is said to have secondary enuresis when she begins passing urine in bed at night after having been dry for at least six months. This type of bedwetting is usually triggered by a stressful event in the child's life, like a family conflict, divorce of parents or birth of a sibling. Urinary tract infection, diabetes and neurological issues are some other causes of secondary enuresis.

What symptoms may be associated with bedwetting?

As a parent, you should look for signs such as increased thirst, increased frequency of urination, urgency, straining (applying pressure to pass), dribbling of urine, weak urine stream, pain after passing urine, constipation and soiling of clothes due to stools (encopresis).

How common is bedwetting in children?

For children in the age group of 5-15 years, the prevalence of bedwetting is as follows:

• 5 years: 16%
• 6 years: 13%
• 7 years: 10%
• 8 years: 7%
• 10 years: 5%
• 12-14 years: 2-3%
• 15 years: 1-2%

At what age should a child stop wetting the bed at night?

• Generally, most children achieve daytime bladder control by the time they are four years old.
• They are expected to achieve night-time bladder control by the age of five to seven years.

Is it normal for a 6 to 10-year-old to wet the bed?

• If the child continues bedwetting at age seven and beyond, it could be a sign of an underlying medical problem.
• The child may have problems with the urinary bladder or spinal cord, and could require further tests.

What are the treatments for bedwetting?

• Treatment for bedwetting is considered for children who are over seven to eight years old.
• The treatment method is usually determined based on the intensity of the habit and the family history.
• Motivating the child to quit bedwetting at night is an important part of the treatment.

Are there home remedies for bedwetting?

Some of the things you can try are:

• Encouraging regular urination
• Limiting fluid intake towards the evening
• Encouraging urination before bedtime
• Getting a bedwetting alarm

When should you see a doctor?

• If bedwetting doesn't stop even after the child is seven years old, it is a good idea to consult the doctor to check for any underlying medical problem.

Which specialists treat bedwetting?

• For any medical issues with your child, the first doctor you should consult is her paediatrician.
• If needed, he may refer your child to specialists such as the paediatric urologist or nephrologist.

What type of exams and tests are performed to assess bedwetting?

To understand the causes of bedwetting:

• The doctor may look at the child's complete medical history
• Discuss the family history
• Perform a physical examination
• Perform urinalysis or urine culture with imaging tests like X-rays

Caffeine and bedwetting

What is caffeine and how does it affect our body?

Caffeine is a naturally occurring alkaloid. Its chemical name is trimethylxanthine. Caffeine is a stimulant of the central nervous system and has a bitter taste.

After consuming caffeine, an individual experiences an increase in energy levels, alertness and attention. Caffeine also increases the heart rate, respiratory rate and blood pressure. It is perhaps the most-consumed psychostimulant globally.

Where do children get caffeine from?

Most of us think that caffeine is found naturally only in coffee. But, this isn't the truth. Caffeine is present in more than sixty plants. It is toxic for several insects and animals. So, it's a natural pesticide that plants produce to protect themselves.

Caffeine is naturally present in plant products like tea leaves, cocoa beans, kola nuts, and Amazonian maple guarana berries.

Some of the common food products consumed by both adults and children that contain caffeine or to which caffeine is added are:

• Chocolate products: The amount of caffeine present in chocolate products like chocolate bars, chocolate chips, chocolate fondue and chocolate drinks depends on how much cocoa the product contains.
• Chocolate and coffee-flavoured snacks/desserts: Many snacks and desserts like ice cream, cake, waffles and biscuits are flavoured with chocolate or coffee. These also contain caffeine.
• Chocolate-flavoured products like breakfast cereals: Nowadays, packaged breakfast cereals like cornflakes and oatmeal are replacing the traditional fare. Chocolate-flavoured breakfast cereals can also contain caffeine.
• Tea: Caffeine occurs naturally in tea. The longer the brewing time, the higher the amount of caffeine in the drink.
• Soft drinks, soda and energy drinks: Manufacturers say that they add caffeine to enhance the flavour of these products.
• Over-the-counter pills: Many analgesic pills contain caffeine. It is added to improve and quicken the body's absorption of the medication. This way, it takes less time for the medication to take effect.

Note: An exception in chocolate products is white chocolate, which is made from cocoa butter and does not have cocoa. So, it does not contain caffeine.

How does caffeine affect children?

Children can show the side effects of caffeine even when they have consumed a very little amount. Some of the symptoms children may show after having caffeine are:

• Trouble sleeping
• Upset stomach
• Difficulty concentrating
• Headaches
• Nervousness

Children who get used to caffeine can show symptoms of withdrawal once it is stopped. Signs of caffeine withdrawal are headache and irritability.

Can caffeine cause bedwetting?

Nowadays, just as adults do, most children unknowingly consume caffeine-containing products. Within 45 minutes of having these foods, caffeine gets absorbed by the body. However, the effect of caffeine lasts for several hours, as it has a half-life of around 5 hours.

To understand why caffeine is thought to cause bedwetting, we need to understand its effect on our body and the urinary bladder.

Caffeine is a diuretic, which means it stimulates the body to produce more urine. It also affects the smooth muscles of the urinary bladder and causes involuntary bladder contraction. As a result, there is increase in the frequency of urination and the urge to urinate.

A study by Lohsiriwat et al found that consuming caffeine resulted in an increase in urine volume, early urgency and frequency of urination. It also caused an increase in night-time urination. So, consuming caffeine does increase urinary bladder activity.

Also, although some studies have found that children slept fewer hours at night after consuming caffeine, there are no studies that conclusively prove that caffeine is responsible for children wetting the bed.

How to stop bedwetting

Although unintentional, when a child wets the bed, it causes distress to both the child and the parents. The child feels embarrassed and the parents feel inconvenienced and helpless. But, there are a few things that parents can do to help their child stop wetting the bed, such as:

• Control fluid intake: Parents can increase their child's fluid intake during the day, morning and afternoon, but cut it down towards the evening.
• Put in place a urination schedule: Encourage the child to go to the toilet at regular intervals, and make it a habit.
• Get a bedwetting alarm: These are alarms with a moisture sensor that is placed inside the child's pajama. The alarm is triggered as soon as the child begins passing urine.
• Consult the doctor: If bedwetting doesn't stop even after the child is five to six years old, it is a good idea to consult the doctor to check for any underlying medical problem.

How do you use a bedwetting alarm?

A bedwetting alarm has two parts: (1) A urine/moisture sensor and (2) an alarm (attached to the sensor with a cord or a cordless one).

In case of a wired model, place the urine/moisture sensor in your child's underwear and attach the alarm to your child's arm or fasten it in his nightsuit's pocket. If it's a cordless model, you can keep the alarm near the pillow or on a nearby table.

But, before beginning the use of a bedwetting alarm, explain its purpose and how it works to your child. Not only will he learn how to use the alarm, but also feel motivated.

How do you clean a bed after the child has wet it?

You will need the following: A piece of cloth or towel to dab with, a vacuum cleaner, a 50:50 mixture of white vinegar and water in a spray bottle, detergent and baking soda.

1. After removing the bed sheet, dab the wet area with the cloth to soak up as much urine as possible.
2. Spray the water-vinegar mixture on the area and sprinkle a little detergent over it. Wait for 10 to 15 minutes.
3. Dab the area with cloth again to remove as much liquid and detergent as possible.
4. Now, sprinkle the baking soda over the area and allow for 10 to 15 minutes to pass.
5. Remove the soda with a wet cloth and use the vacuum cleaner to clean the remnants.
6. Switch on the fan to allow the mattress to dry. You can also use a blow dryer, if you have one.

If you find that the odour of urine persists, repeat the process once again.

Bedwetting is a hassle, but it is not something that a child does intentionally. While trying to get a child to stop the habit, it is important to motivate him to become an equal partner in the process.

About the expert:

Reviewed by Dr Jyothi Raghuram on 31 December 2019

Dr Jyothi Raghuram is an experienced paediatrician working with a leading hospital in Bangalore. She has a special interest in Paediatric Rheumatology. Her favourite part of being a doctor is the opportunity to directly improve the health and well-being of her patients and to develop professional and personal relationships with them.

About the author:

Written by Arun Sharma on 30 December 2019

The author was associated with the healthcare industry before becoming a full-time writer and editor. A doting father to two preteens, he believes in experiential learning for his children. Also, he loves mountain trekking and nature trips.

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