What are the treatment options for bedwetting?

Photo of children at playground
PantherMedia / Warren Goldswain

Bedwetting is more common among children and teenagers than many people think. Nighttime “accidents” can be troubling for the entire family. But the problem usually goes away on its own over time. In the meantime, there are various things you can do to help your child. Whichever approach you choose, the main thing is to be patient.

Research has found that electronic alarm systems can help. These include bedwetting alarms in underwear or in special bed mats. Certain medications can help at least some children, too.

But because most children eventually stop wetting the bed on their own, it's difficult to tell whether a particular approach actually helped, or whether the child’s bladder control developed on its own during that time.

It's important not to scold or punish the child, putting them under pressure. To be able to control their bladder, various things in their body have to develop first. This takes longer in some children than in others. They can't help it. And it's not unusual. Parents aren't to blame, either.

When is it a good idea to consider treatment?

A lot of children who still wet the bed at the age of five grow out of it after a while, without any treatment. The problem often becomes more urgent when a child starts school. As well as the child’s age, other factors also play a role when deciding whether or not to try out treatment: How much of a problem is the bedwetting for the child and parents? For instance, does he or she often sleep at a friend's house? Does the child want to stop wetting the bed? Is he or she willing to give treatment a try?

If bedwetting causes the child to suffer, treatment can be a good idea even if nighttime accidents are rare. But there is also little point in trying out treatment if the child doesn't want to, or isn't yet mature enough.

What can you do yourself?

When dealing with a bedwetting problem, parents and children usually try out a simple behavioral approach first. There are a number of different approaches, including:

  • Reward systems: These approaches involve rewarding the child if they reach certain goals – for instance, if they regularly go to the toilet before going to bed, or if they help you to make the bed after wetting it. You agree on a suitable reward beforehand, such as stickers or temporary children's tattoos. The child may get a sticker to be put in a calendar every time a goal is reached, and if they have collected enough stickers by the end of the week, they may be given a tattoo or other small reward. Reward systems are most suitable for young children.
  • Going to the toilet at certain times in the night: Most children are used to going to the toilet just before bedtime. Parents can also take the sleeping child out of their bed and carry them to the toilet, or wake them at a certain time every night so they can go to the toilet themselves. This doesn't help the child to develop nighttime bladder control, but it can help them to stay dry on those nights Older children can set an alarm clock to wake them up in the night, so they can go to the toilet on their own.
  • Limiting drinks before bedtime: Some parents try to get their child to stop wetting the bed by making sure that she or he doesn't drink much, or anything, in the evening. But children should be allowed to drink if they are thirsty. Diuretic (urine-increasing), caffeinated and sugary drinks like cola should be avoided.

There is only little research on simple behavioral approaches for the treatment of bedwetting. But reward systems and "just-in-case" trips to the toilet give parents a simple way to support their child.

There is also an approach known as bladder training, but this generally isn't recommended. In this approach, the child tries to hold their urine in for as long as possible during the day. This is supposed to increase the volume of the bladder and help the child learn what a full bladder feels like. But there is no scientific proof that bladder training has an effect on bedwetting. Studies that compared bladder training with other treatments found it to be less effective.

How do electronic bedwetting alarms work?

Electronic bedwetting alarms detect wetness and trigger an alarm if the child starts to pee. The alarm is designed to wake the child as soon as the very first drops of urine come out. This way, the child can stop the urine flow and then go to the toilet – on their own or with the help of their parents. Over time, the child should learn to wake up whenever their bladder gets too full, before the alarm goes off.

There are various types of bedwetting alarm systems, including underwear with built-in sensors, mats with built-in sensors, and mini-alarms that can be put inside the child’s underwear or pajamas. Some systems work with light signals or vibrations, and others are wireless. In Germany, the costs of certain alarm devices are generally covered by statutory health insurers, as long as they have been recognized as a medical aid and are prescribed by a doctor. Bedwetting alarms typically have to be used over a period of several weeks.

Although the child and their parents have to be determined and patient, they are often rewarded with long-term success. The disadvantage: When using bedwetting alarms, the child and their family may be woken several times per night and then feel tired the next day.

How effective are bedwetting alarms?

There have been a large number of studies on bedwetting alarms such as special underwear and bed mats. One review that summarized the results of these studies found the following after several weeks of use:

  • Without a bedwetting alarm, only 3 out of 100 children stayed dry on at least 14 nights in a row.
  • With a bedwetting alarm, 62 out of 100 children stayed dry on at least 14 nights in a row.

Some children started wetting the bed again when they stopped using an alarm system. But most of them were still dry at night several weeks or months later.

Parents are often advised to keep using the bedwetting alarm until their child has stayed dry at night over a period of two to four weeks. But there is no official recommendation here. The time it takes to start working can be very different from child to child, varying from a few weeks to six months.

One reason why bedwetting alarms don't always work is because some children sleep very deeply, and still don't wake up when the alarm sounds.

The risk of starting to wet the bed again can be reduced by adding a second training phase after successful treatment with a bedwetting alarm. In the second training phase, the now "dry" child drinks more than usual in the hour leading up to their bedtime (about 0.2 liters more). In this way, he or she can learn to wake up quickly enough with a particularly full bladder, too.

What kinds of medication are there, and when are they considered?

Bedwetting problems can also be treated with medication. Two medications have been proven to temporarily stop bedwetting in some children: the hormone-like medication desmopressin and the antidepressant imipramine. Both need to be prescribed by a doctor.

When people decide to treat bedwetting problems with medication, desmopressin is typically used. It starts working quite fast, sometimes even the first time it is taken.

Desmopressin can be used if, for instance, the child is staying overnight at a friend's house and would like to avoid wetting the bed. It is best to try out this medication in advance, to make sure that it works and that the dose is correct.

Medication may also be used if bedwetting alarms aren't suitable – for instance, if the child doesn't wake up when the alarm sounds.

One disadvantage of medication is that it usually only works temporarily, while you take it. Some children start wetting the bed again after they stop taking it.

If medication is used over a long period of time, it’s important to have a break after around three months of use, where the child stops taking it for about a week. That way you can see whether he or she still needs treatment – or can now stay dry at night without any help.

How effective are medications?

Desmopressin works in a similar way to the hormone , which is made naturally in the brain at night to reduce urine production.

Research has found the following:

  • Without desmopressin, 3 out of 100 children have dry nights on at least 14 nights in a row.
  • With desmopressin, 19 out of 100 children have dry nights on at least 14 nights in a row.

About 5 out of 100 children who take desmopressin tablets have side effects such as headaches and stomach ache. Most of these arise because too much water stays inside their bodies. To avoid side effects, children and teenagers who take the medication should stop drinking in the hour before they take it. They should also not drink more than one glass of liquid in the eight hours after taking the medication. This is important in order to prevent another side effect called water intoxication, too. Although rare, water intoxication is serious. It happens if too much water stays inside your body. Early signs of water intoxication include a headache, nausea, vomiting, dizziness and weight gain.

When stopping treatment with desmopressin, it may be a good idea to gradually lower the dose over a few weeks. This can lower the risk of starting to wet the bed again.

Imipramine

Imipramine is a tricyclic antidepressant. Although it is mainly used in the treatment of depression, it has also been approved for the treatment of bedwetting. Imipramine shortens the dream phases of sleep (REM phases), increase the production of , and affect the bladder muscles.

It is about as effective as desmopressin, but often leads to side effects. In studies, imipramine led to side effects in about 17 out of 100 children. The side effects included low blood pressure, palpitations, a dry mouth, constipation, sweating, nausea, tiredness and sleep problems. It is important to keep imipramine out of reach of children because an overdose could be life-threatening for them.

Other medications and treatments

Other medications and treatments haven’t been proven to stop bedwetting. Complementary or alternative treatments like medicinal plants, chiropractic treatment, homeopathy, hypnosis and haven’t been shown to help here, either. They haven’t been tested in good-quality studies, so it’s difficult to draw any reliable conclusions.

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National Institute for Health and Care Excellence (NICE). Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. 2010. (NICE Clinical Guidelines; Volume 111).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 5, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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