What You Need to Know About Bed-Wetting

Is bed-wetting normal or cause for concern? We asked two experts from UChicago Medicine and Comer Children’s.

Nothing disrupts a parent’s sleep quite like a wet bed. Whether your child appears at your bedroom door with the obvious signs of a midnight accident or — worse! — they slide in next to you, only to warm your bed in a most unwelcome way, bed-wetting brings new meaning to the wee hours.

When is bed-wetting a normal childhood event and when is it something to truly worry about? We asked two experts from the University of Chicago Medicine and Comer Children’s Hospital to get the latest information on bed-wetting and kids.

“Generally, bed-wetting is an umbrella term for a variety of symptoms,” says Shireen Hashmat, MD, pediatric nephrologist with UChicago Medicine and Comer Children’s. “It may refer to urinary incontinence at night but also involuntary accidents or leaking during the day. Most of the time, parents use the term bed-wetting, but it’s not just in the bed.”

At what age bed-wetting is considered a problem is related to parents’ perceptions, Hashmat says, but parents typically become concerned if their child is not completely dry at night by age 5 or 6.

Brain-bladder connection

To better understand bed-wetting and why it happens, it’s good to know how the urinary system works in young kids. Infants wear diapers because their bladders are still maturing and building connections to the brain.

“Around the age of 2, children sense they need to (experience) toilet training and that’s where the parents come into play,” explains Mohan Gundeti, MD, pediatric urologist and surgeon with UChicago Medicine and Comer Children’s. While kids as young as 18 months to 2 years old can be dry during the daytime, nighttime dryness takes a little longer, and that’s normal, Dr. Gundeti says.

In time — typically between age 2 and 5 — the bladder has grown enough to accommodate urine at night. “We need a big (enough) container to stay dry,” Dr. Gundeti says.

Commonly, bed-wetting occurs because the child’s brain and bladder are just not yet synchronized. “The bladder-brain train has not matured yet,” explains Dr. Hashmat.

Still, if a child has accidents during the day and is not staying dry at night after the age of 5, parents should seek medical help, both experts say. “Also, if a child has been dry for six months and then has secondary bed-wetting, at any age, this is concerning,” Dr. Hashmat says.

Other causes

One contributor to bed-wetting is family history. “Sometimes parents on either side will say their aunt or cousin or dad or mom had this issue and were never dry until 12 or 13,” Dr. Gundeti says. “There is some genetic component here.”

Sleep issues, like obstructive sleep apnea, can cause nighttime incontinence in children, too. “We have found recently that enlarged tonsils or adenoids cause snoring or sleep apnea that can contribute to nighttime incontinence,” Dr. Gundeti says.

Sometimes, however, bed-wetting is simply behavioral. “During the daytime, a child is running around, is busy at school and then sports, and then is drinking buckets of water in the evening and then falls asleep,” Dr. Gundeti says. Caffeinated and carbonated beverages can irritate the bladder, which is a highly sensitive organ. “Highly acidic drinks or carbonated water can irritate the bladder and cause bed-wetting and even daytime accidents. This is very common in children,” he says.

“The kidneys are doing their job right, but the child is drinking too much at night and the signals are not mature. In this case, the timing of liquids matters,” Dr. Hashmat says.

Finally, don’t discount the impact of constipation. Just like two kids in the backseat of a car, bladder and bowel can sometimes fight for space. “Whenever you have a slow bowel movement, the stools accumulate for a long time and can push the bladder and not allow it to stretch, and now you have bed-wetting,” Dr. Gundeti says.

What to try

If you’re concerned because your child’s bed-wetting persists, start with the simple things first, the experts say. Encourage beverage consumption throughout the day and restrict liquids in the evenings. Avoid constipation.

Team up with your child and provide plenty of positive reinforcement, suggests Dr. Hashmat. Recognize dry nights with a sticker chart. Even helping with the laundry can help a child recognize that they are taking control, she says.

After making sure that a visit to the bathroom is the last task before bed, you can set alarms to wake your child in the night to make a preemptive trip to the bathroom. And, you can try using a potty alarm, which is a moisture sensor device placed in the underwear that will sound an alarm or vibrate. “These devices can be expensive and need to be used for three or more months. Three-quarters of kids who use a potty alarm for this length of time will achieve dryness,” says Dr. Hashmat.

When to visit the pediatrician

If lifestyle efforts aren’t successful, consider seeking a medical opinion, the experts say.

Less commonly, bed-wetting can be caused by a structural abnormality or kidney disease. Any time your child experiences bed-wetting after a period of extended dryness is cause for concern. “If they were potty trained at 3 or 4 and then at 6 or 7 they are having accidents, get to the doctor right away,” Dr. Hashmat says. “This could be a sign of kidney disease or something new like diabetes, or even a stressor that your child can’t handle.”

The bladder is a sensitive organ, says Dr. Gundeti. “It’s controlled by the spinal cord and the brain and could be impacted by social issues like parental separation, bad things happening at school, peer pressure or bullying,” he says.

Your child’s pediatrician will set the wheels in motion to rule out problems with bladder development, spinal cord integration or abnormalities of the kidneys, ureter or urinary tract.

“The problem could be simple, but we do want to rule out abnormalities, because there can be congenital renal, bladder or urethral anomalies or spinal cord issues where the control of the bladder is,” says Dr. Gundeti.

Learn about UChicago Medicine and Comer Children’s unique approach to care. Discover uchicagomedicine.org.

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