Here are some interesting issues to consider if your child is wetting the bed at night:
Girls are easier to potty train than boys. And, fewer girls wet the bed at night. In fact, two-thirds of all child bedwetters are male. And most bedwetters – nearly 80 percent, in fact – have a parent who was a bedwetter, too. What are the reasons for the preponderance of male bedwetters or for inheriting bedwetting from a parent? Actually, there is little research to explain it, only anecdotal evidence, mostly from pediatricians and parents.
There is much debate – and little agreement – on exactly why children wet their beds at night, when they are asleep. Some think that bedwetting is caused by an underlying physical or emotional problem, yet many disagree with that theory and say, instead, that the number of children whose bedwetting is caused by a physical problem is only 1 out of 3 of every bedwetter. Now, children who have already gained bladder control at night but relapsed into bedwetting are more likely to have a medical cause for their relapse than children who never gained bladder control at night. And there are medical problems that can cause nighttime wetting, or enuresis. The most common are urinary tract infections, diabetes, and spinal cord problems.
Many experts on enuresis believe that the majority of bedwetters, especially adolescent bedwetters, are sleeping too deeply. One sign of this is this is their trouble waking up in the morning, their mood swings, and their signs of ADD or ADHD characteristics, even though they don’t suffer from those disorders.
One of the newest theories about bedwetting that is gaining traction is the theory that it is caused by constipation, which puts extra pressure on the rectum, which in turn puts pressure on the bladder to release – at night! What’s plausible about this theory is that the modern American diet is so full of constipating foods, from too many refined carbohydrates to too little fiber, especially in the form of fresh fruits and vegetables.
Treating enuresis with medication or alarm systems (to awaken a child who has wet the bed) are also highly debatable subjects. Some physicians suggest medicating a bedwetter who is older but others wholeheartedly disagree with that treatment, especially those treating enuresis with behavior modification.
Some experts believe children should wear a nighttime diaper until bedwetting stops. Others, including the Mayo Clinic, say children past a certain age should never be diapered at night.
Some experts suggest using an alarm to wake children who are bedwetters; others say never to use an alarm for bedwetting.
That’s the list of basic issues, including many of the debates. If you have a bedwetter, and if you take comfort in knowing that you are not alone, consider that, according to the American Academy of Pediatrics, children who are toilet-trained during the day may still wet the bed two to three times a week – until they are 5 years old. Even then, about 1 in 4 children will still wet the bed at night. By age seven, 1 in 7 children will still be bedwetting, by age 10, that statistic goes down to 1 in 20 who will have occasional bedwetting incidents. Oy! What’s a parent to do?!!
Find the cause of your child’s bedwetting
Ah, as the previous section suggests, finding the cause of a child’s bedwetting at night is easier said than done, since experts and even parents disagree so much on the issue, and since both toilet training – and children – run the gamut, too!
First comes the debate about whether a child should be having liquids just before bedtime or sipping liquids throughout the night. Some say that it’s okay – and even good – to be drinking water or liquids, especially water or breast milk, before falling asleep, and that through the night, the child’s bladder should be mature enough to hold the liquid until morning, or the child should be able to awaken and go to the toilet to void. Others say that liquids, including breast milk for toddlers, should be limited before going to sleep and that a major cause of bedwetting is drinking before bedtime or during the night. One theory.
Another theory is that children who wet the bed at night have an undiagnosed medical problem, such as a urinary tract infection, diabetes, or a back problem that causes the nerve to the bladder to be pinched. While this is true for some bedwetters, as you learned in the first section it is true for only a very few of them – less than 3 percent. Still, if you think your child might have a physical problem, then take your child to the pediatrician or even to a pediatric urologist. You’ll sleep better having ruled out a physical problem and sleep better dealing with the situation if there is one.
Sometimes a trauma in a child’s life can cause a bedwetting problem, for a few days or even longer. This trauma could be a death in the family, a divorce or even the birth of another sibling. And dealing with such emotional causes of bedwetting, to be honest, are beyond the scope of this blog; instead consult with a physician or counselor or someone with experience treating it.
Still another theory, and one of the most common, is that enuresis is caused by a sleep issue that prevents the child from either staying dry through the night or prevents the child from waking up to void in the toilet if the child does need to urinate. These sleep problems include sleeping too deeply or not going through enough of the REM sleep cycle.
Time out for a basic sleep lesson. There are basically two kinds of sleep: non-REM and REM. Non-REM is the sleep cycle that occurs first and which is referred to as “restorative sleep” since it is the cycle where the body tends to restore itself. In contrast, REM cycles are for dreaming and for taking what you studied or learned before you went to sleep and incorporating it into your brain. It’s the longest period tends to occur at the end of sleeping, just before waking up. Infants, perhaps because they are learning so much and their brains are growing so much and so rapidly (they triple in size in a year), do more REM sleeping than an adult, which may be why an infant sleeps so much during the day. But don’t quote me on this – I love reading and learning about sleep but the person to read if you want to know more about sleep is Dr. Michael Breus, author of a number of books about sleep; my favorite is The Sleep Doctor’s Diet Plan: How to Lose Weight through Better Sleep. Back to the topic of bedwetting.
One of the reasons that critics chastise use of an alarm to help cure enuresis (the alarm goes off when the pad it is attached to gets wet from urine from a nighttime bedwetting accident) is that the alarm tends to wake up the parents, but rarely awakens the sleeper who is the bedwetter! They are so deep in their non-REM sleeping that they never hear the alarm and when someone wakes them up after the alarm goes off, they are often disoriented. On the other hand, the Mayo Clinic recommends using alarms but states that they can take 2 weeks to 3 months to be effective.
Whatever the cause of bedwetting, both experts and parents are divided over what to put on a child who is wetting the bed at night.
As you can see in any store that sells disposable diapers, today there seems to be countless sizes and categories of diapers, even within the same company, with varying degrees of absorbency. The nighttime diapers and diapers for older toddlers are the most absorbent, of course. Being extra absorbent allows more urine to collect in the diaper, which allows the sheets to stay dry and prevents the child from getting a diaper rash, since the urine gets wicked away from the skin. Hey, even the choice range for adult diapers takes up more shelf space than ever before.
The Big Divide, if you want to call it that, is whether to put a bedwetting child in a diaper, in an extra absorbent panty, or to allow the child to sleep in regular bed clothing, on a waterproof pad that is either on top or underneath the bed’s bottom sheet. Even that issue has its debate: over whether to use disposable pads or pads that get laundered again and again! As stated earlier, the Mayo Clinic suggests using pads, not diapers. But some children sleep better knowing – and having the security – that they may wet the diaper but not the bed. Thus, wearing a diaper allows them to sleep through the night. Much depends on the particular child, as this shows. Is it better to be a bedwetter who sleeps through the night or a light sleeper who doesn’t wet the bed? And honestly, that’s too complicated for a short blog article and is better as a carefully considered decision, so discuss it with your pediatrician, parents and other wise and informed souls.
Some parents find bladder training for their child helpful. For this “remedy” the child is taught how to perform exercises that strengthen the bladder and help coordinate the muscles that connect the bladder to the urethra, the tube the urine that travels from the bladder to either the penis opening or out the vagina. These techniques include determining how much urine the bladder is capable of holding (if it is small, the therapy will help the child increase the bladder’s capacity, which means holding more liquid and urinating less often). Other techniques that can be helpful include stretching the bladder, which as the previous sentence suggests, helps delay urination. Some experts suggest drinking more fluid during the day, then less before sleeping, and not at all during the night. Still another technique is to teach, through biofeedback, how to wake up when a bladder is full and needs to be voided, then how to easily get back to sleep (counting sheep?).
What I’ve learned about bedwetting from raising children, reading books about the issue, and scouting advice on websites devoted to the issue
Most children wet the bed because they are sleeping too deeply, but it is important to have a bedwetter checked by his pediatrician, a pediatric urologist or the specialist in order to rule out a physical problem, such as a urinary tract infection, diabetes or other serious medical problems.
Take into consideration your ability to change wet sheets, launder more than usual and even launder large items, such as bed quilts, blankets, and mattress covers. Weigh those considerations against your child’s particular personality and needs. Some children are comfortable in nighttime diapers while some would be appalled to wear them, especially when visiting a friend or even relative overnight.
Never resort to punishment for bedwetting: for some it is a physical problem they will often outgrow, or an emotional problem, but sometimes need help with; for most it is a problem that needs intervention such as bio-feedback but not punishment! Punish a child who intentionally does the wrong thing, acts aggressive or obnoxious or inappropriately but refrain from punishing, or even scolding a child for bedwetting they can’t help.
Try the bedwetting behavioral programs before trying medicine. Some experts don’t believe in giving medicine for bedwetting; others believe in giving it only when a child is on an overnight visit and the threat of teasing and psychological pain is worse than the medicine.
One natural, over-the-counter treatment is a melatonin supplement, used for people whose waking pattern is more nocturnal than daytime. Other common medications used for treating bedwetting that require a prescription are desmopressin, usually administered as a nasal mist, imipramine, which acts on both the brain and the urinary bladder and helps with incontinence but is only totally effective in about 1 out of 5 people taking it, and a class of medications called anticholinergics, which are used to control muscle spasms that may cause an overactive bladder. By the way, never borrow a medicine from another bedwetter; always ask your doctor before even trying over-the-counter remedies.
Some experts say a child should not be exposed to the toxins in the plastic and other materials used to manufacture disposable pads. Others, including the manufacturers of such pads, strongly disagree. Like organic milk, butter and yogurt, it may be prudent not to prove them right or wrong, but to take the “safe road,” as the saying goes, and use flannel-covered rubber sheeting. If you or someone you know can, stitch an old sheet to the top of the rubber sheeting. Then it looks less like a pad and more like a sheet – to the child and to his or her friends or siblings. Or, it is probably possible to buy rubber-proof pads that are covered with sheets or decorative fabric.
This was an interesting topic to research but clearly one that requires far more than a short or even medium-length article. For many parents, bedwetting is one of the most challenging aspects of childrearing, especially for parents who have more than one child wetting the bed in the household or who have too much laundry and other responsibilities to do without the added burden of all those wet bed linens. Parents who suffered bedwetting themselves may be more compassionate and more tolerant, but not necessarily more knowledgeable about solving the problem. Yet as the research shows, they will be more likely to have a child who is also a bedwetter and to put that compassion to work. All parents who deal with enuresis, however, are dealing with a challenging issue in parenting, regardless of what style of parenting they are embracing. It is especially challenging issue when on vacation, visiting family or friends, or when the rest of life seems overwhelming or challenging.
A few years ago I read comedian Sarah Silverman’s memoir, The Bedwetter, a surprisingly good read, so good that I often recommend the book to others, both to friends who want to study standup comedy or put more humor into their writing, and to parents whose children are bedwetters, especially who are still wetting the bed during their adolescence, since she was a bedwetter until she was 16 years old. Ms. Silverman’s book offers a serious look at the effect of the issue on her personal life, as well as other issues including her parents’ divorce. But most important to this discussion, her story is a reminder that bedwetting is far more common than many people realize, and as difficult and embarrassing as you would expect it to be. Or maybe you hadn’t thought much about it if you were lucky enough not to suffer from it, even occasionally.
There are numerous books for children about bedwetting, though primarily picture books for younger children, not teenagers (which is why Sarah Silverman’s book is so good). You can read them to your child even if your child doesn’t wet the bed. Why? For the sake of teaching understanding and compassion for those who are bedwetters.
General parenting books include the topic and there are also books by experts on the issue, available at numerous websites devoted to bedwetting and toilet training.
As I said before, I have experience with the topic but am no expert on it. Still, it is interesting to see how much information is out there; interesting, too, to see how little agreement there is on some of the ways to treat bedwetting. It helps to remember that if your child is a bedwetter, and especially if they are an older bedwetter, that neither you nor your child is alone. It also helps knowing that the overwhelming odds – 99 to 1 – are that “this, too, shall pass.”