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ASK A USCF BENIOFF OAKLAND CHILDREN’S HOSPITAL OAKLAND/WALNUT CREEK EXPERT:

Angelique Champeau; Pediatric Nurse Practitioner, Continence, Spina Bifida and Urology clinics at UCSF Benioff Children’s Hospitals

Q: My child is almost six and is still wetting the bed at night. Is this a common problem at this age?

A: Nighttime bedwetting is the most common issue of bladder control in childhood. Nighttime bedwetting, also known as “nocturnal enuresis,” is the involuntary loss of urine during sleep for a child that is 5 years old or older. Fifteen percent of 5-year olds and 10 percent of 6-year olds experience bedwetting. As children get older, that number reduces by about 15 percent per year. Bedwetting does tend to run in families, but this is not always the case. If one or both parents have had trouble with bedwetting, their children have an increased chance of having similar problems.

Q: What causes nighttime wetting?

A: The most common causes include constipation, bladder dysfunction – when children are not urinating enough during the day – or a genetic predisposition. Psychological problems were once thought to be the cause of nighttime bedwetting, but this is no longer believed to be the case. Most urologists feel that the difficulty lies with a developmental delay in the bladder’s urination cycle. These children simply need more time for their nighttime control to fully develop. Just as some children walk and talk before others their same age, bladder control also varies per child.

Q: Does my child wet at night because he/she is a deep sleeper?

A: Children who wet at night do not have abnormal sleep patterns. Children often wet the bed during deep sleep, which causes parents to think that their child is a deep sleeper. Many children who visit the doctor for bedwetting issues also have daytime urologic symptoms like regularly needing to urinate urgently, frequently, or have accidents.

Q: What should parents do if their child is experiencing nighttime wetting?

A: Since bedwetting is very common until children reach 7 years old, it is difficult to justify treatment for nighttime wetting in his age group unless the cause is bowel or bladder dysfunction. At any age, decisions regarding treatment should take into account the extent that the problem affects the child and the child’s level of motivation. Quite often, the child has no physical abnormality and does not need long-term, expensive therapy. Parents should make sure that their child urinates before bedtime and they should also reduce the amount of fluid that a child drinks close to bedtime.

Q: When should parents seek treatment?

A: All children who need treatment for bedwetting benefit from treatment of constipation first. When children hold their bowel movements, the amount of stool increases and stretches the rectum, putting pressure on the bladder and can cause it to leak. An X-ray of your child’s abdomen may be recommended to determine if this is the case. If a child with nighttime wetting has a normal history and physical examination, further testing beyond an X-ray is not usually necessary. Treatment will always consist of first treating constipation and bladder dysfunction. Once these conditions are treated, if the bedwetting persists, a pediatric urologist can prescribe medication, conditioning, or suggest trying a combination of approaches.