Bedwetting

The main reason why some children and teenagers wet the bed is because they don’t wake up when their bladder is full. Instead, their bladder muscles relax, emptying the bladder while they are still asleep. Children who wet the bed at night simply don’t realize that their bladder is full. This is because the development processes needed for bladder control have not yet been completed. These processes include:

• The child’s brain is able to detect and process nerve signals from the bladder so that they wake up when their bladder is full. They also have to develop control over their bladder muscles, which can take a while.
• Their body produces enough antidiuretic hormone (ADH) at night. This hormone, also called vasopressin, makes the kidneys produce less urine at night.
• Their bladder has to be big enough to store the urine that is produced at night.

Genetic factors also seem to play a role in how long it takes for children to stop wetting the bed. Bedwetting is more common in children whose parents or close relatives also had problems with bedwetting.

Many children just wet their bed once or twice a month, while others do so several times a week. Bedwetting is more common among boys than it is among girls. The problem almost always goes away on its own over time.

The following table shows how many children still wet the bed at different ages:

Sometimes children stay dry for more than six months and then suddenly start wetting the bed again. This is called “secondary enuresis.”

It may be a sign that the child is under emotional stress – for instance, due to changes within the family, like the birth of a sibling, or because of family problems. Secondary enuresis might also have a physical cause such as a kidney or bladder infection, epilepsy or diabetes.

Doctors refer to bedwetting when a child is older than five, has not been dry for more than three consecutive months, and wets the bed at least once a month.

Bedwetting is only rarely a sign of a medical problem. Doctors can rule out other possible causes, including a urinary tract infection, kidney disease, early-stage diabetes mellitus, or, in rare cases, pauses in breathing during sleep (sleep apnea).

To rule out these kinds of problems, the doctor will talk with the parents and their child, and also carry out a physical examination. The doctor might ask the following questions:

• Do they need to use the toilet very rarely (fewer than 3 times a day) or very often (more than 8 times a day)?
• Do they wet themselves or leak a bit during the daytime as well?
• Do they have problems when peeing (such as getting the flow started or emptying their bladder all at once, without interruptions)?
• Do they have a weak urine stream?
• Does it hurt when they urinate?
• Do they have the feeling that their bladder isn’t empty afterwards?

It can be helpful to keep a “bladder diary” and write down what, when, and how much the child drinks, as well as when and how often they need to use the bathroom. It is often helpful to also record how much urine is passed each time. The doctor can give you some advice on the best way to do this and what else you need to keep in mind when keeping the diary.

Rapid urine tests can be done to rule out things like urinary tract infections and diabetes. If there are signs that a medical condition is causing the bedwetting, further testing may be needed.

There’s a lot of advice out there about what to do about bedwetting – but there are no simple answers. It is especially important for the child and the family to know the following:

• What causes the bedwetting
• That it’s nobody’s fault
• That it usually goes away on its own over time

If bedwetting nevertheless becomes a burden for everyone, there are several options to consider. In order for these suggestions to help, the child must be willing and mature enough to participate.

You can try the following steps:

• Spread out your daily fluid intake differently: The child then drinks enough during the day – until around 5 p.m. – that they are hardly thirsty at all in the evening. They drink only very small amounts in the two hours before bedtime.
• Remind the child to use the bathroom before bedtime
• Small rewards when the child sticks to the mutual goals – like regularly going to the bathroom before bedtime
• Electronic alarm systems such as alarm in underwear or special mats: They detect wetness and set off an alarm that wakes up the child as soon as they start to pee. They can help you stop drinking. Bedwetting alarms don’t work in some children because they sleep too deeply.

No matter what you decide: You can always try a different approach, or combine different approaches. The same measures do not help all children.

Medication only has a temporary effect and generally isn’t recommended in children under the age of seven. It works quickly, but only for as long as it is taken. But it can help if the child needs to stay dry for a short period of time – for example, when sleeping away from home. Bedwetting medication usually has the drug desmopressin in it, which is similar to the hormone vasopressin that is produced in the body.

Many parents and children already feel better knowing that bedwetting isn’t abnormal, and a lot of other families are affected too – and that the problem will very likely go away on its own.

Being prepared for nighttime accidents can make things easier in everyday life – for instance, by protecting the child’s mattress with waterproof rubber mats or covers, and having fresh sheets and bedding on hand. Then everyone can get back to sleep quickly. Some families use diapers or special absorbent pants for older children.

It is important for the child to take a shower in the morning so they don’t smell like urine. To get rid of the urine odor in bed linen and clothes, things like baking soda or eucalyptus oil can be used in the wash.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.