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.
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.
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.