A child may have a bladder control problem if they leak urine (urinary incontinence) by accident and are past the age of toilet training. Daytime urinary incontinence, also called daytime wetting, is broadly defined as involuntary, sporadic leaking of urine throughout the day in children 5 years of age and under. Nighttime urinary incontinence (nocturnal enuresis) is more commonly referred to as bedwetting and happens when a child urinates without control while they are sleeping. 

Many children gain control over their bladders between the ages of 2 and 4 years old, although occasional wetting is still common in children between the ages of 4 and 6 years old. By 4 years old, an age when most children can stay dry during the day, daytime wetting can be upsetting and embarrassing. By age 5 or 6, children may have a bedwetting problem if they wet the bed once or twice a week (or more) for a few months.

“Treatments for pediatric incontinence like medications and bedwetting alarm devices aren’t recommended until a child is at least 6 years old,” says Stacy Tanaka, MD, a pediatric urologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt University.

To diagnosis daytime or nighttime wetting, your doctor may ask you to keep track of your child’s bathroom habits in a “bladder diary.” If more information is needed, your doctor may order a blood test, urine test or bladder scan.

Understanding Daytime Wetting

While all the causes of daytime wetting are not known, some explanations do exist. For example, some children’s bladders are not big enough to hold their urine and this can cause daytime wetting. In other children, their bladder is big enough, but has spasms (contractions) that cause urine to leak. Some children get so busy playing with their friends or participating in classroom activities that they forget to “listen” to their bladder telling them that it’s time to go to the bathroom. When they realize that they have to pee, it’s too late. Additional causes of daytime wetting include urinary tract infections, constipation and drinking certain beverages like soda that may irritate the bladder. 

If daytime wetting is causing your child anxiety or affecting their social relationships, you may want to talk to your pediatrician about behavioral and/or medication strategies that may be right for your family. Your pediatrician may also ask if your child is experiencing nighttime wetting.

“Daytime and nighttime wetting can be connected, but they are different issues,” says Tanaka. “If a child has bedwetting alone without any daytime incontinence, the treatment is different than for a child who has both daytime and nighttime wetting issues.” She notes that if nighttime and daytime wetting are both occurring, then the daytime incontinence should be addressed first. 

Understanding Bedwetting 

About 5 million children in the United States experience bedwetting. Although many children outgrow bedwetting issues, some children take longer than others to do so. 

“Bedwetting is very common and no one knows why some kids outgrow bedwetting when they’re 3 years old and others outgrow bedwetting when they’re 20 years old,” said Tanaka. 

There are 2 types of bedwetting. “Primary nocturnal enuresis” is when a child over the age of 5 never has a dry night. “Secondary nocturnal enuresis” is when a child has dry nights for at least 6 months, but then starts wetting the bed again. 

Common causes of bedwetting include family history (genetics), slow development of bladder control, small bladders, stress and making too much urine while asleep. Bedwetting often occurs in children who are heavy or “deep” sleepers. Deep sleepers generally don’t wake up in time to get to the bathroom once they get the signal from their bladder that they need to urinate. 

If your child is having issues with bedwetting, your doctor will also want to know if the child is going to the bathroom more frequently during the day, even if they’re not having accidents. It’s important for your health care team to understand the full scope of urinary issues. Potential strategies may include bedwetting alarms or medications. 

It’s also important to know that if a child’s only symptom is bedwetting, rarely is that considered a true medical concern. But it can be a social concern for some children. For example, if you have an 8 year old boy who is wetting the bed, but it’s not affecting his social activities or how he feels about himself, then the bedwetting does not necessarily have to be treated. 

Bedwetting Alarm Devices

Bedwetting alarm devices are the most effective treatment for bedwetting, notes Tanaka. With these devices, a sensor is placed in the child’s underwear or pull up. An alarm goes off when the censor gets wet. Of course, by the time the sensor gets wet, it’s too late to get to the bathroom in that moment. Bedwetting alarm devices work by repetition. If the child routinely wakes up when they’re wetting the bed, the bedwetting eventually stops.

One challenge with bedwetting alarm devices is that they can be difficult to use and often involve other people. For example, children who are deep sleepers may need their parents or caregivers to be responsible for waking them up when the alarm goes off. Another challenge with these devices is that families have to be consistent with using them. Bedwetting alarm devices won’t work if they’re only used occasionally. 

“Bedwetting alarm devices need to be used every night for about 3 months,” says Tanaka. “And some kids will wet the bed multiple times a night, so you can imagine if mom or dad has to get to work in the morning or there are other kids in the house, this can be difficult.” 

Insurance does not typically cover bedwetting alarm devices. The general price range is between $100 and $150. Given the time and cost investment, it’s important for families to seriously consider whether these devices are a good option for their household. 

Medications for Bedwetting

Medications may also be appropriate to help with bedwetting. For example, if a child is wetting the bed and they’re scared to go a sleepover or school trips because of it, then that may be a situation when a doctor might consider medications notes Tanaka. On the other hand, if your child doesn’t seem to be concerned or negatively affected by bedwetting, it’s also fine not to use medication. 

Parents should know that first line medications for bedwetting like Desmopressin Acetate (DDAVP) don’t work for all kids. You may need to explore other medication options for your child. 

General pediatricians are able to manage many wetting issues. But because there are so many things that general pediatricians have to treat, they may refer some patients to a pediatric urologist who has more time to spend with the patient and is more familiar with evidence-based strategies for treating urinary incontinence in children. For example, strategies like restricting liquids close to bedtime or waking a child up in the middle of the night to take them to the bathroom have not been proven to help stop bedwetting. 

Remember that urinary incontinence is not your child’s fault. Be patient and never punish your child for accidents. For more information, visit UrologyHealth.org

More Information

For more information about Pediatric Urology, watch our Pediatric Urology video below, or visit  youtube.com/urologycarefoundation.

UrologyHealth.org  |  SUMMER 2019  |  UROLOGYHEALTH extra