Introduction and Risk factors
Bedwetting or involuntary passing of urine during sleep is quite common
in children. In most cases it spontaneously resolves without any treatment
as children grow up. However it is still worrisome for the children and
their families because it causes inconvenience and embarrassment. It is
not due to kidney disease, laziness or naughtiness of children.
What percentage of children suffers from bedwetting and at
what age does it normally stop?
Bedwetting is common especially under the age of 6 years. At the age
of 5 years, bedwetting occurs in about 15 to 20 % of children. With
increasing age, there is a proportionate decrease in the prevalence of
bedwetting: 5% at 10 years, 2% at 15 years, and less than 1% in
Which children are more likely to suffer from bedwetting ?
- Children whose parents have had the same problem in childhood.
- Those with delayed neurological development which reduces the
child’s ability to recognize a full bladder.
- Children with deep sleep.
- Boys are affected more often than girls.
- Increased psychological or physical stress may be the trigger.
- In a very small percentage of children (2%-3%), medical problems
such as urinary tract infection, diabetes, kidney failure, pin worms,
constipation, small bladder, abnormalities in the spinal cord or defect
in the urethral valves in boys, are responsible.
Bedwetting at night is a common problem
in young children, but it is not a disease.
190. Save Your Kidneys
When and which investigations are performed for bedwetting
Investigations are performed only in selected children when medical or
structural problems are suspected. The most frequently performed tests
are urine tests, blood glucose, X-rays of spine and ultrasound
examination or other imaging tests of the kidneys or bladder.
Bedwetting is completely involuntary and is not done intentionally.
Children should be reassured that bedwetting will stop or be cured
over time. They should not be scolded or punished.
Initial treatment for bedwetting includes education, motivational therapy
and change in habits of fluid intake and voiding. If bedwetting does not
improve with these measures, bedwetting alarms or medications may
1. Education and motivational therapy
- The child must be thoroughly educated about bedwetting.
- Bedwetting is not the fault of the children so they should not be
blamed or admonished about bedwetting.
- Take care that no one teases the child for bedwetting. It is important
to reduce the stress the child suffers due to bedwetting. The child’s
family should be supportive and the child should be reassured that
the problem is temporary and it is sure to be corrected.
- Use training pants instead of diapers.
- Ensure easy access to the toilet at night by properly arranging night
With increasing age, a sympathetic approach and
motivation will cure the problem of bedwetting.
CHP. 24. Bedwetting in Children 191.
2. Limit fluid intake
- Keep an extra pair of pajamas, bed sheet and a towel handy, so that
the child can change bed linens and soiled clothing conveniently if he
wakes up due to bedwetting.
- Cover the mattress with plastic to avoid damage to the mattress.
- Place a large towel underneath the bed sheet for extra absorption.
- Encourage daily bath in the morning so that there is no urine smell.
- Praise and reward your child for a dry night. Even a small gift is an
encouragement for a child.
- Constipation must not be neglected, it should be treated.
3. Advice on voiding habits
- Limit the amount of fluid the child drinks two to three hours before
bedtime, but ensure adequate fluid intake during the day.
- Avoid caffeine (tea, coffee), carbonated drinks (cola) and chocolate
in the evening. They can increase the need to urinate and aggravate
- Encourage double voiding before bed. First voiding at routine bedtime
and second voiding just before falling asleep.
- Make it a habit to use the toilet at regular intervals throughout the
- Wake the child up about three hours after he falls asleep every night
to void urine. If necessary, use an alarm.
- By determining the most likely time of bedwetting, the waking time
can be adjusted.
Limiting fluid intake before bedtime and discipline in voiding
habits are the most important measures to prevent bedwetting.
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4. Bedwetting alarms
5. Bladder training exercises
- The use of bedwetting or moisture alarms is the most effective method
for controlling bedwetting and is generally reserved for children older
than 7 years of age.
- In this alarm a sensor is attached to the child’s underwear. When the
child voids in bed, the device senses the first drops of urine, rings
and wakes up the child. The woken up child can control his urine
until he reaches the toilet.
- The alarm helps in training the child to wake up just in time before
the bedwetting problem.
6. Drug therapy
- Many children with bedwetting problems have small bladders. The
goal of bladder training is to increase the capacity of the bladder.
- During day time children are asked to drink a large quantity of water
and told to hold back urine in spite of the urge to pass urine.
- With practice, a child can hold urine for longer periods of time. This
will strengthen the bladder muscles and will increase bladder capacity.
Medications are used as a last resort to stop bedwetting and are generally
used only in children over seven years old. These are effective, but do
not “cure” bedwetting. These provide a stopgap measure and are best
used on a temporary basis. Bedwetting usually recurs when the
medication is stopped. Permanent cure is more likely with bedwetting
alarms than with medications.
Bedwetting alarms and drug therapy are generally
adopted for children older than 7 years of age.
CHP. 24. Bedwetting in Children 193.
A. Desmopressin Acetate (DDAVP):
Desmopressin tablets are
available in the market and prescribed when other methods are
unsuccessful. This drug reduces the amount of urine produced at night
and is useful only in those children who produce a large volume of
urine. While the child is on this medication, remember to reduce evening
fluid intake to avoid water intoxication. This drug is usually given before
bedtime and should be avoided at night when the child has, for any
reason, drunk a lot of fluids.
Although this drug is very effective and has few side effects, its use is
limited because of its prohibitive cost.
Imipramine (a tricyclic antidepressant) has a relaxing
effect on the bladder and tightens the sphincter and thereby increases
the capacity of the bladder to hold urine. This drug is usually used for
about 3-6 months. Because of its rapid effect, the drug is taken one
hour before bedtime. This drug is highly effective, but because of frequent
side effects it is used selectively. Side effects may include nausea,
vomiting, weakness, confusion, insomnia, anxiety, palpitations, blurred
vision, dry mouth and constipation.
Oxybutynin (an anticholinergic drug) is useful for
daytime bedwetting. This drug reduces bladder contractions and
increases bladder capacity. Side effects may include dry mouth, facial
flushing and constipation.
For bedwetting, drug therapy is an effective stopgap
measure for short term benefit but it is not curative.
When should one consult a doctor for children with
The family of a child with bedwetting should immediately consult a doctor
if the child:
- Has a day time bedwetting problem.
- Continues bedwetting after the age of seven or eight years.
194. Save Your Kidneys
- Starts bedwetting again after at least six months of a dry period.
- Loses control in defecation or passing stools.
- Has fever, pain, burning and frequent urination, unusual thirst, and
swelling of the face and feet.
- Has poor stream of urine, difficulty in voiding or needs to strain
In cases of daytime bedwetting accompanied by fever, burning in
urination or bowel difficulties, consult your doctor immediately.