Overview

Bed-wetting — also called nighttime incontinence or nocturnal enuresis — is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a normal part of a child's development.

Generally, bed-wetting before age 7 isn't a concern. At this age, your child may still be developing nighttime bladder control.

If bed-wetting continues, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medication may help reduce bed-wetting.

Source: http://www.mayoclinic.com

Symptoms

Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

When to see a doctor

Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.

Consult your child's doctor if:

• Your child still wets the bed after age 7
• Your child starts to wet the bed after a few months of being dry at night
• Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring

Source: http://www.mayoclinic.com

Causes

No one knows for sure what causes bed-wetting, but various factors may play a role:

• A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
• Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
• A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
• Urinary tract infection. This infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination.
• Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring and daytime drowsiness.
• Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
• Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
• A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

Source: http://www.mayoclinic.com

Diagnosis

Depending on the circumstances, your doctor may recommend the following to identify any underlying cause of bed-wetting and help determine treatment:

• Physical exam
• Discussion of symptoms, fluid intake, family history, bowel and bladder habits, and problems associated with bed-wetting
• Urine tests to check for signs of an infection or diabetes
• X-rays or other imaging tests of the kidneys or bladder to look at the structure of the urinary tract
• Other types of urinary tract tests or assessments, as needed

Source: http://www.mayoclinic.com

Complications

Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. However, bed-wetting can create some issues for your child, including:

• Guilt and embarrassment, which can lead to low self-esteem
• Loss of opportunities for social activities, such as sleepovers and camp
• Rashes on the child's bottom and genital area — especially if your child sleeps in wet underwear

Alternative medicine

Some people may choose to try complementary or alternative medicine approaches to treat bed-wetting. For approaches such as hypnosis, acupuncture, chiropractic therapy and herbal therapy, evidence of effectiveness for bed-wetting is weak and inconclusive or such efforts have proved to be ineffective. In some cases, the studies were too small or not rigorous enough, or both.

Be sure to talk to your child's doctor before starting any complementary or alternative therapy. If you choose a nonconventional approach, ask the doctor if it's safe for your child and make sure it won't interact with any medications your child may take.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Here are changes you can make at home that may help:

• Limit fluids in the evening. It's important to get enough fluids, so there's no need to limit how much your child drinks in a day. However, encourage drinking liquids in the morning and early afternoon, which may reduce thirst in the evening. But don't limit evening fluids if your child participates in sports practice or games in the evenings.
• Avoid beverages and foods with caffeine. Beverages with caffeine are discouraged for children at any time of day. Because caffeine may stimulate the bladder, it's especially discouraged in the evening.
• Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it's OK to use the toilet during the night if needed. Use small night lights, so your child can easily find the way between the bedroom and bathroom.
• Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate every two hours or so, or at least often enough to avoid a feeling of urgency.
• Prevent rashes. To prevent a rash caused by wet underwear, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a protective moisture barrier ointment or cream at bedtime. Ask your pediatrician for product recommendations.

Source: http://www.mayoclinic.com

Coping and support

Children don't wet the bed to irritate their parents. Try to be patient as you and your child work through the problem together. Effective treatment may include several strategies and may take time to be successful.

• Be sensitive to your child's feelings. If your child is stressed or anxious, encourage him or her to express those feelings. Offer support and encouragement. When your child feels calm and secure, bed-wetting may become less problematic. If needed, talk to your pediatrician about additional strategies for dealing with stress.
• Plan for easy cleanup. Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy. However, avoid the long-term use of diapers or disposable pull-up underwear.
• Enlist your child's help. If age-appropriate, consider asking your child to rinse his or her wet underwear and pajamas or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
• Celebrate effort. Bed-wetting is involuntary, so it doesn't make sense to punish or tease your child for wetting the bed. Also, discourage siblings from teasing the child who wets the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents. Use a sticker reward system if you think this might help motivate your child.

With reassurance, support and understanding, your child can look forward to the dry nights ahead.

Source: http://www.mayoclinic.com

Risk factors

Bed-wetting can affect anyone, but it's twice as common in boys as in girls. Several factors have been associated with an increased risk of bed-wetting, including:

• Stress and anxiety. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
• Family history. If one or both of a child's parents wet the bed as children, their child has a significant chance of wetting the bed, too.
• Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.

Source: http://www.mayoclinic.com