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're still asleep.

Children don't wet the bed on purpose. They simply don't notice that their bladder is full. Certain things need to develop in their body first. These include the following:

• The child’s brain has to be 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 has to produce enough antidiuretic hormone (ADH) at night. This hormone, also called vasopressin, makes the kidneys produce less urine (pee) 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 other close relatives also had bedwetting issues when they were young.

Many children only wet the bed one or two times per month, and others do so several times a week. Bedwetting is more common among boys than it is among girls. The problem usually 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, or diabetes.

Doctors consider it to be "bedwetting" if a child is over five years old and wets the bed more than once a week for at least three months.

Bedwetting is only rarely a sign of a medical problem. Doctors can rule out possible causes. These include urinary tract infections (UTIs like cystitis), kidney problems, early-stage diabetes and breathing pauses during sleep (sleep apnea).

To rule out these kinds of problems, the doctor will talk with the child and their parents, and also do a physical examination. They will ask about things like whether the child

• pees very rarely (less than three times a day) or very often (more than eight times a day),
• wets themselves or leaks a bit during the daytime too,
• has problems when peeing (e.g. getting the flow started or emptying their bladder in one go, without interruptions),
• has a weak stream,
• experiences pain when peeing, or
• has the feeling that their bladder isn't empty afterwards.

It can be helpful to keep a "bladder diary" for at least two days to record what, when and how much the child drinks, and when and how often they pee. It often makes sense to measure the amount of pee that comes out, too. The doctor can advise you on how to do this and what else you should record in the diary.

Rapid urine tests can be done to rule out things like urinary tract infections and diabetes. If there's reason to believe that the bedwetting is being caused by a medical problem, other tests or examinations may be needed.

There's a lot of advice out there about what to do about bedwetting – but there's no easy solution. The most important thing is that the child and their parents understand

• why children wet the bed,
• that it's nobody's "fault" and
• that the problem usually goes away on its own over time.

If the bedwetting is still troubling for everyone, there are various things you can do. These things can only help if the child is mature enough and wants the situation to change, too. Ideally the whole family should be involved.

• You can try to change how much the child drinks at different times of the day. In other words, make sure they drink enough before 5pm so that they're no longer thirsty after that. Then they won't need to drink much in the last two hours before going to bed. Caffeinated or sugary drinks such as lemonade and cola should be avoided especially in the evening.
• You can remind the child to go to the toilet before they go to bed.
• You could briefly wake them at night, too, so they can go to the toilet then.
• One simple behavioral measure is giving the child small rewards if they stick to certain goals like going to the toilet every night before going to sleep.
• Electronic bedwetting alarms (e.g. in special underwear and mats) detect wetness and then set off an alarm to wake the child up as soon as the first few drops leak out. These alarms can help children to stop wetting the bed. But they don't work in children who have a very deep sleep.

No matter what you decide to do, it is always possible to try out a different approach or use several at once.

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. Still, 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 made in the body.

Many parents and children already feel better knowing that bedwetting isn't abnormal, that 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 special covers, and having fresh sheets and bedding on hand. Then everyone can get back to sleep quickly. Some families use diapers (nappies) or special absorbent pants for older children.

It is important to have the child shower in the morning. This can help prevent negative reactions from friends or at school. To get rid of the urine smell in bedding and clothes, things like antibacterial laundry sanitizer, baking soda or a few drops of eucalyptus oil can be used in the wash.

If a child has a health-related problem, parents usually go to see their pediatrician or family doctor first. You can read about how to find the right doctor in our "Health care in Germany" topic, and our list of questions can help you to prepare for your appointment.