Underlying causes of bedwetting
There can be underlying health conditions causing your child's bedwetting which need to be ruled out and treated if necessary.
Underlying causes of bedwetting include:
- Constipation – if your child's bowels become blocked with hard poo, it can put pressure on the bladder and lead to bedwetting. Read about the signs of constipation and how it needs to be treated.
- If your child has daytime bladder problems, this needs to be investigated by a healthcare professional first.
- A urinary tract infection (UTI) can make your child’s wee painful, causing frequency and urgency in their bladder.
- Type 1 Diabetes. Alongside bedwetting, other symptoms of this can include feeling thirsty, frequent weeing, weight loss, hunger, blurred vision, tummy pain, vomiting, thrush and tiredness. You must take your child to the doctor if they have these symptoms to be tested.
When children have an additional need or physical disability, it's important their bedwetting should be assessed as it may not be related to their existing condition(s).
Get more information about the causes and treatment of bedwetting in our factsheet: Advice for Children with Night Time Wetting
Sudden onset bedwetting
Secondary bedwetting (also known as sudden onset bedwetting) is when a child starts to wet again after at least six months of being dry.
The causes of this include:
- An underlying health condition such as Type 1 Diabetes (see symptoms in section above). If you think your child could be diabetic, call your doctor so they can be tested.
- Urinary tract infection or constipation, which both need treating.
- Periods of change and stress in a child’s life can also explain why they may suddenly start to wet again after even a long stretch of dryness.
- Vasopressin, the hormone that controls how much wee we produce at night can be affected by anxiety. When children feel worried, they produce less vasopressin, so bedwetting is more likely.
Sudden onset bedwetting must be assessed and treated in the same way as primary bedwetting (when a child has never become reliably dry at night).
How to stop children wetting the bed
To stop bedwetting, first you need to know what the cause is, so the right treatment can be given.
The evidence shows the sooner your child is assessed and treated for bedwetting, the better chance they have of becoming dry at night.
NICE guidelines recommend that all children still bedwetting over age 5 should be given a bladder and bowel assessment by a healthcare professional.
Contact your GP for an appointment. There may be a bedwetting or enuresis clinic in your area that your child can be referred to.
Things to do before your appointment:
- Check whether your child is drinking plenty during the day and what they're drinking
- Make sure they are emptying their bladder before they go to sleep
- Complete a night-time diary to record wet and dry nights
- Keep a poo diary if you think your child is constipated
Our bedwetting animation explains more about the things you can try to improve your child's chance of being dry at night.
Using a bedwetting alarm
- A bedwetting alarm is likely to be the ideal treatment for 'poor arousability' (when children find it hard to wake to a full bladder).
- Alarms are a highly effective way of training a child to become dry at night but can be hard work at first.
- Your child will need to feel motivated to stop bedwetting and mature enough to cope with the disruption. This is why it's important to talk to your doctor or nurse before trying this treatment.
How does the alarm work?
A bedwetting alarm has a sensor attached to an alarm. When the sensor gets wet, it sets the alarm off, and this should wake your child up. Over time, the alarm helps your child to learn when they need to wee and wake up to go to the toilet.
We sell a wide range of body worn and bed mat alarms in our online shop.
Alarms aren't available on the NHS, but you may be able to borrow one from your local enuresis (bedwetting) or continence clinic.
Alarms and children with additional needs
There are alarms available for children with additional needs which vibrate and flash. These can be less frightening for a child on the autistic spectrum, for example.
Get more information about using an alarm and the different types available.
Bedwetting alarm tips
- Bedwetting alarms need to be used for at least 4 weeks. They rarely work straight away. This is because your child needs to get used to waking up and responding to it.
- It’s a good idea to encourage your child to practise setting off the alarm before they go to sleep so they know what to expect.
- Explain to your child what needs to happen when the alarm goes off e.g. get out of bed, go to the bathroom, change their pants/pyjamas and strip the bottom sheet.
- You may choose to sleep in the same room at first, so you are near in the night when it goes off and whilst your child is learning what they need to do.
How will we know it it’s working?
- At first, your child may empty their bladder before they respond to the alarm. Over time, they will learn to stop the flow of urine when the alarm sounds.
- Progress might just be smaller wet patches at first. Try to keep going until you’ve had 14 dry nights in a row and then you can stop.
- If there’s been no progress after 12 weeks, stop the treatment and have a break for a few months before trying again.
- It can take 2 - 3 months on average for a child to be consistently dry at night. Some children will take longer.
More tips for using an alarm
- Reward your child for drinking well during the day and for helping change wet bedding rather than for keeping their bed dry (this is beyond their conscious control).
- Avoid only rewarding nights when they don't wet the bed.
- Clean the sensor every morning to prolong its life. Replacement sensors can be bought from our shop.
- If your child wets more than once a night, you will need to re-attach the alarm to clean underwear after each wetting episode. As your child makes progress, the nightly wetting episodes will decrease.
- Even if your child is sure they will no longer wet the bed, encourage them to continue to wear the alarm until they have had 14 dry nights in a row.
- Children occasionally have another accident after they appear to be able to stay dry through the night. If this happens, use the alarm again until they have achieved another 14 dry nights.
- Stopping using the alarm before your child is fully dry at night can lead to a relapse.
If a bedwetting alarm doesn't help or isn't suitable for your child, treatment with medicines is usually recommended.
Your doctor may suggest a medicine called Desmopressin. Given an hour before sleep, it works by ‘topping up’ the body’s levels of the hormone vasopressin and tells the kidneys to produce less wee at night. It can be taken regularly or just for nights away.
Get more information on using desmopressin as a treatment for bedwetting.
If desmopressin or a bedwetting alarm (or a combination of both) doesn't help, your child may be referred to a specialist, who may recommend other medicines.
Managing bedwetting day to day
Wetting at night is not as big a problem if you can find ways to manage it. Here are some things to try:
- Before your child sees a health professional, encourage them to get into good bladder and bowel habits: Make sure they poo regularly (at least 4 times a week) and treat any underlying constipation.
- Assess and treat daytime bladder problems first (wetting accidents or urgency for example).
- Drink plenty during the day: 6 - 8 glasses of water-based fluid is best. Only have a small drink before going to bed if necessary and ideally stop drinking an hour before bedtime.
- Make sure your child fully empties their bladder before they go to sleep.
- Move them to the bottom bunk from the top if they share a room. Have a night light and bucket to help if they wake in the night for a wee.
- If they wear a pull up at night, have a trial of a few days without one on. Make sure your child understands what they need to do in the night and their bed is well protected. A waterproof under sheet makes changing the bed much easier and saves washing the lower sheets.
- Reward your child for drinking well during the day and for helping change wet bedding rather than for keeping their bed dry, which is beyond their conscious control.
- Think positively; they can try repeating the phrase "I can be dry!" as they get into bed.
Tips for nights away from home
Bedwetting shouldn't stop your child from joining in with camps and sleepovers.
Here are some tips for a stress free night away:
- Reassure your child that wetting the bed is common and the chances are they won’t be the only one on the trip who has wetting accidents.
- Be prepared. There are lots of products that can help such as pads, pull-ups, sheet covers, special underwear and sleeping bag liners.
- Desmopressin can be taken for a one off trip, but your child would need to try it beforehand to work out the right dose and make sure it helps them to be dry.
- If your child is taking a sleeping bag they could hide a pull-up or pad at the bottom.
- If their underwear or pyjamas are also inside the sleeping bag, they can get dressed for bed in private.
Bedwetting and younger children
There isn’t a fixed rule about when to stop using nappies at night as every child is different. If your child can stay dry during a nap, or for 2 or more hours during the day they may be capable of staying dry overnight.
Helping your child master daytime potty training will have taught them many of the skills they need to stay dry at night.
Here are some tips to promote night time dryness in under 5s:
- Make sure your child is drinking enough in the day and try to avoid large amounts of fluids at bedtime.
- Stop drinks an hour before bedtime OR plan to help them use a potty at night (e.g. if your child is breastfeeding at night).
- Help them get into a routine of using the potty or toilet before they go to sleep.
- Protect the bed with a waterproof sheet and try putting them to bed without a nappy to see how they manage.
- Expect some accidents and understand that these are a very important part of the learning process.
- Some children may need to use a potty at night, so make sure you have a potty in their room if possible and a gentle light by the bed.
- If your child wakes up at night, help them to use the potty or toilet.
Bedwetting and teenagers
It’s common for older children to deny their bedwetting and not want to talk about it with you. Hiding wet sheets can be a way of coping with the embarrassment they feel. It’s happening outside their conscious control, and they may secretly worry about it.
There are ways to support your child to manage their wetting such as keeping a diary of wet versus dry nights to see if they can spot a pattern.
If treatments aren’t working, ask your doctor or nurse to make a referral for your child to be seen by a specialist.