The simplest advice is often the hardest to take, but here goes: don’t worry about bedwetting. It is completely normal–2o percent of kids who are otherwise completely toilet trained experience nighttime wetting, even into kindergarten age. Kids who already enjoy dry nights and sound sleep can be in for a change now that school has started. But there’s no need to despair, even in the face of setbacks.
“Kids who are potty trained during the day, and who have never had a significant period of nighttime dryness have what we call primary nocturnal enuresis or primary bedwetting,” says Natasha Burgert, MD, FAAP, a pediatrician in Kansas City, Missouri. “Kids who had some success for nighttime dryness, and who have perhaps started school and now are having accidents again might be diagnosed with secondary nocturnal enuresis. Both are very normal, but there are two different things to think about here.”
Primary bedwetting often correlates with family history, but it’s mainly caused by bladder size. There can be other health situations that lead to bedwetting–snoring, obesity, and obstructive sleep apnea are a few – but in the vast majority of cases, bedwetters simply don’t have big enough bladders. It’s not stubbornness or laziness – it’s anatomy. And the most effective treatment is patience until they grow a little bigger. Starting too early with bladder training can cause a lot of stress for an endeavor that has no chance of success. “I see parents trying all of these tricks – they don’t give the child drinks at night or they wake the child up every three hours to go to the bathroom – going through this rigmarole without seeing any success, because the child simply can’t do it,” says Burgert.
In fact, primary bedwetting can last well into elementary school, and that’s normal too. “For kids with primary nocturnal enuresis, we typically don’t worry about them until they’re 8, 9, even 10 years old,” Burgert explains. Once a kid starts to demonstrate some intermittent dryness, bladder training can start.
“Using bedwetting alarms is probably the most common and the most evidence-based technique for bladder-training success,” Burgert says. “We also have to keep in mind that about 2 percent of the population even as adults are still wetting the bed, so there can be a wide spectrum of success here.”
But the kid has to be invested in staying dry. Children who enjoy the attention they get from parents while bedwetting may not be initially motivated to get up and go to the bathroom at the alarm’s prompting. Eventually, maturity and social opportunities like sleepovers encourage recalcitrant bedwetters to cooperate with bladder training.
The Four-Pronged Approach to Tackling Bed-Wetting
- Ensure that your child isn’t stressed or exhausted during the day to help them achieve a healthy sleep.
- Use a bedwetting alarm for bladder-training, which wakes a child to get up and go to the bathroom at the alarm’s prompting.
- Resolve constipation-related bedwetting with aids such as stool softeners or gummy fiber supplements.
- Don’t over-stress. It’s normal for toilet-trained kids to experience nighttime wetting, even well into elementary school.
With secondary nocturnal enuresis from kids who have enjoyed prolonged periods of dry nights and who return to bedwetting, the answers aren’t quite as clear. “The cause of this particular wetting sometimes requires a little bit more of an investigative process,” says Burgert. “Usually pediatricians need to tease out the reasons why the child has started wetting. It can correlate to more primary developmental or physical problems. They may have diabetes, or a UTI, or they are having some stressful expressions of a developmental delay. We see those sometimes when kids are dry until 5, 6, or 7 and all of a sudden they are having accidents again.”
There’s still a correlation with family history, and sometimes the causes are still fairly mundane: When kids head back to school, they can be exhausted by the end of the day. They’re not yet on their school sleep regimen. “They’re having really deep periods of REM sleep, in which they’re urinating at night and have complete unawareness of where they are,” Burgert explains. “We just have to wait for their bodies to get into the school routine and it resolves itself.”
Sometimes the problem comes with different sets of bathroom habits. Kids who are reluctant to use the toilet at school or daycare can become constipated, and that’s an issue. There isn’t a lot of room in those young abdomens, and a constipated colon doesn’t leave much room for a bladder that needs to expand. The result is nighttime incontinence. Assisting the child with aids such as stool softeners or gummy fiber supplements can help resolve constipation-related bedwetting.
Good advice is hard to take, but here it is again: Don’t worry about bedwetting because stress makes things worse.
“Stress is a huge factor,” explains Burgert. “Stress is a reason why kids start wetting the bed again. Going to school can be stressful. Change is stressful. With co-parenting families, kids might wet the bed at one parent’s home, and maybe not the other parent’s home. That can be an indicator of a stressful separation.” Showing frustration during early-morning accidents can pile on the stress for kids who are already self-conscious about their bedwetting.
While most kids grow out of bedwetting, parents should consult with their pediatrician, especially if they have any specific concerns. In secondary enuresis, when bedwetting can be symptomatic of other problems, a pediatrician is likely to investigate a little bit more, maybe running urinalysis, lab panels, or even an x-ray. There are a few other techniques pediatricians can do to temporarily manage both primary and secondary bedwetting, but the most common long term solutions come down to patience and time.