Are sleepovers and summer camps a concern for your school-age child? Is your child still struggling with wetting the bed at night?
You might be surprised that your child is far from alone. Up to 5 million youngsters struggle with nighttime bedwetting, known as nocturnal enuresis.
"It's important to know that while bowel and bladder dysfunction is common in kids and teens, it doesn't mean it has to be 'normal,'" said Cassandra Dalton, PT, DPT, a physical therapist who specializes in pelvic floor therapy at Franciscan Health. "These issues are often difficult for both kids and parents to talk about and can impact all aspects of day-to-day life."
At What Age Is Bedwetting Considered A Problem?
Typically, children are toilet trained by age 4 with only very occasional accidents. If a child is still experiencing bowel or bladder incontinence or constipation from the age of 5 and older, it is considered a medical problem that may impact the quality of life of the child.
"At 5 years of age, most children (about 85%) are able to stay dry overnight," said Indianapolis area pediatrician Aubrey Bonhivert, MD, who practices at Franciscan Physician Network Pediatric Associates of Greenwood. "If a child is still wetting the bed at age 5 or older, we call it nocturnal enuresis."
How Common Is Bedwetting Among Older Children And Teens?
"Many children may still have problems with bedwetting into childhood, and sometimes even into adolescence," Dr. Bonhivert said. "One in 10 children age 7 still have issues wetting the bed. That number decreases to 5% at age 10, and 1-2% at 15+ years of age."
What Causes Bedwetting Among School-Age Children Or Even Teens?
"For many children, bedwetting is simply a delay in the maturation or development of the bladder and its communication with all of the nerves and muscles involved with the bladder holding urine overnight," Dr. Bonhivert explained. "This can sometimes run in families; so if either parent had issues staying dry overnight as a kid, their child is more likely to have the same issues."
For some children, bedwetting may be a sign of another problem. Possible causes or risk factors for bedwetting include:
- Attention deficit/hyperactivity disorder (ADHD)
- Certain genes
- Constipation that puts pressure on the bladder
- Delayed bladder development
- Not enough antidiuretic hormone (ADH) in the body during sleep
- Obstructive sleep apnea
- Overactive bladder
- Slower physical development
- Small bladder
- Structural problems in the urinary tract
- Trouble feeling that the bladder is full while asleep
- Urinary tract infection
- Very deep sleep
"These other problems, however, are typically accompanied by additional symptoms that help pediatricians identify the problem," Dr. Bonhivert said. "Also, some children have voiding dysfunction in general, which will impact daytime continence as well."
Will My Child Grow Out Of This, Or How Do I Know They Need Treatment?
The majority of children and teens will grow out of bedwetting.
"Treatment is considered when it becomes a 'problem' to the patient and family," Dr. Bonhivert said.
"The point at which bedwetting is considered a problem may be different for each family. One important factor to consider is if the child is ready and willing to participate in their treatment plan. Treatment may be indicated if it is causing social distress (such as not being able to participate in sleepovers) or if the child has not grown out of it by puberty."
Are There Behavioral Changes For Bedwetting We Should Try At Home First?
Pediatricians often recommend trying the following home strategies to reduce bedwetting:
- Reward the child for dry nights (similar to using a reward system when potty training).
- Do not punish the child for wetting the bed. This can increase stress, and they may try to hide the problem from you.
- Decrease fluids in the evening.
- Make sure your child is using the toilet regularly during the day and just before going to bed.
- Avoid sugary and caffeinated beverages.
"If the above changes do not help within three months, you might try a bedwetting alarm," Dr. Bonhivert said. "These alarms sense urine and wake the child, prompting them to use the toilet. To figure out if this is effective for your child, give it a three or four-month trial."
When Should My Child See A Pediatrician Or Specialist About Bedwetting?
"If bedwetting is continuing beyond age 5 or is bothersome to your child, talk to your pediatrician," Dr. Bonhivert said. "Your doctor will determine if a referral to a specialist, such as a urologist, is needed."
What Are Treatment Options For Older Children Who Wet The Bed?
Some medications to boost antidiuretic hormone levels in the body or calm bladder muscles may be prescribed by your pediatrician.
"These medicines do not 'cure' bedwetting, but they can be especially helpful for sleepovers or overnight camps," Dr. Bonhivert said. "Usually the bedwetting returns once medications are stopped, unless the child has grown out of their bedwetting in the meantime."
If there are any underlying or associated medical problems, your doctor will address those. For example, children with constipation or daytime incontinence will need a different treatment plan than those with only nighttime incontinence.
Pelvic floor-focused physical therapy can be prescribed as well. This type of physical therapy focuses on the musculoskeletal components of the pelvis and is specifically designed for the treatment of bowel and bladder dysfunction. For some children with incontinence, muscles of the pelvic floor and surrounding structures may be contributing to their symptoms. Treatment in pediatric patients includes education and behavioral modification training, as well as education about the muscles that promote daytime and nighttime continence. A physical therapist can help teach parents and patients about exercises and strategies to promote coordination and control.
Treatment strategies physical therapists may use to help stop bedwetting include:
- Biofeedback: a treatment tool that provides visual feedback and measures pelvic muscle activity.
- Behavioral modification
- Diet and hydration education
- Soft tissue mobilization, myofascial release, therapeutic massage if needed
- Stretching and strengthening of pelvic floor and surrounding muscles
- Relaxation and stress management techniques
How Can I Help My Child Not Be Embarrassed By Bedwetting?
"Parents should reassure their child that bedwetting is not their fault or anything that they are doing wrong," Dr. Bonhivert said. "It is important to reward the dry nights, but never punish the child for overnight accidents."