Most children stop wetting the bed as they get older, but in the meantime there are a number of treatments you can try.
These treatments may help keep your child dry until they grow out of the problem.
Your child's treatment plan
The treatment for your child depends on a number of things, such as:
- how often they're wetting the bed?
- the impact that bedwetting is having, both on your child and on you, your partner and other members of your family
- your childfs sleeping arrangements, such as whether they sleep alone or share a room with other children
- whether there's a short-term need to control your childfs bedwetting ? for example, if they're going away on a school trip
- how your child feels about specific treatments
Depending on your childfs symptoms and how well they respond to treatment, the person in charge of their care will be their GP or a paediatrician (doctor who specialises in treating children).
Alternatively, many clinical commissioning groups (CCGs) run bedwetting clinics, also known as enuresis clinics, which your GP can refer you to.
There's no single approach to treating bedwetting that works for everybody, but in most cases the recommended plan is to first try a combination of measures yourself.
If these don't work, a bedwetting alarm is often used. If the alarm?is unsuccessful or unsuitable, medication?may be recommended.
The various treatments for bedwetting are outlined below. You can also read a?summary of the pros and cons of the treatments for bedwetting, allowing you to compare your treatment options.
Measures you can try yourself
The below measures?may prevent, or at least reduce, episodes of bedwetting.
Controlling fluid intake
Drinking too much or too little can contribute to?bedwetting. Ensuring your child gets the right amount of fluid each day is often recommended.
Although the amount of fluid your child needs can vary depending on things like how physically active they are?and their diet, there are some general recommendations for daily fluid intake. These are:
- boys and girls 4 to 8 years old ? 1,000 to 1,400ml (1.7 to 2.4 pints)
- girls?9 to 13 years old ??1,200 to 2,100ml (2.1 to 3.7 pints)
- boys 9 to 13 years old ??1,400 to 2,300ml (2.4 to?4 pints)
- girls 14 to 18 years old ? 1,400 to 2,500ml (2.4 to 4.4 pints)
- boys 14 to 18 years old ? 2,100 to 3,200ml (3.7 to 5.6 pints)
However, itfs important to remember that these are just guidelines and many children don't drink this much.
As well as the quantity, timing is also important. Most of the recommended fluid intake should be consumed during the day, with only about a fifth during the evening.
Also, encourage your child to avoid drinks that contain caffeine, such as cola, tea, coffee or hot chocolate, because these increase the need to urinate during the night.
Encourage your child to go to the toilet regularly during the day. Most healthy children urinate between four and seven times a day. You should also make sure your child urinates before going to bed and has easy access to a toilet.
Many parents find reward schemes helpful in managing bedwetting. This is because motivating your child can help bedwetting treatments be more effective.
However, it's important to emphasise that these are only effective when they promote positive behaviour rather than punishing negative behaviour.
Bedwetting is something your child can't control, so rewards shouldn't be based on whether they wet the bed or not. Instead, you may want to give rewards for:
- sticking to their recommended fluid intake
- remembering to go to the toilet before going to bed
It's important not to?punish your child or withdraw previously agreed treats if they wet the bed. Punishing a child is often counterproductive as it places them under greater stress and anxiety, which could contribute to bedwetting.
If you have tried using a reward scheme to improve your childfs bedwetting and it hasn't been effective, there's little point continuing it as it's unlikely to be helpful.
If the above measures don't help, a bedwetting alarm is usually the next step.
A bedwetting alarm consists of a small sensor and an alarm. The sensor is attached to your childfs underwear and the alarm is worn on the pyjamas. If the sensor starts to get wet, it sets off the alarm. Vibrating alarms are also available for children who have impaired hearing.
Bedwetting alarms are not prescribed on the NHS, but you may be able to borrow one from your local clinical commissioning group (CCG). Otherwise, they're available to buy. For example, an organisation called?Education and Resources for Improving Childhood Continence (ERIC) sells alarms?for around ?40 to ?140, depending on the type of alarm.
Over time, the alarm should help your child to recognise?when they need to pee?and wake up to go to the toilet.
Reward systems to promote good behaviour may help, such as getting up when the alarm sounds and remembering to reset the alarm. It also helps to make it as easy as possible for your child to go to the?toilet during the night, such as using night lights.
The alarm will usually be used for at least four weeks. If there are signs of improvement by this point, the treatment will continue. If there's no sign of improvement, treatment is usually withdrawn as it's unlikely to work for your child.
The aim of the alarm is achieve at least two weeks of uninterrupted dry nights. If there's some improvement after three months,?but no sign of this goal being achievable, alternative treatments are usually recommended (see below).?
When bedwetting alarms are unsuitable
Bedwetting alarms require commitment from both children and parents. There may be some situations where they're not suitable. For example, if:
- more immediate treatment is required, for example?because you're finding it emotionally difficult to cope with your childfs bedwetting
- there are practical considerations that make using an alarm problematic, such as if your child shares a room or the alarm disturbs sleep
Some children and their parents may also not like the idea of using an alarm to signify when the child has wet the bed.
If a bedwetting alarm doesn't help or isn't suitable, treatment with medication is usually recommended. The three main medicines used are described below.
Desmopressin?is a synthetic (man-made) version of the hormone that regulates the production of urine, called vasopressin. It?helps to?reduce the amount of urine produced by the kidneys.
Desmopressin can be used:
- to provide short-term relief from bedwetting in certain?situations ? for example, if you're going on holiday or if your child is going on a trip with friends
- as a long-term alternative treatment in situations where a bedwetting alarm is ineffective, unsuitable or unwanted
Desmopressin should be taken just before your child goes to?bed.
The medication reduces the amount of urine your child produces and makes it harder for their body to deal with excess fluid. Therefore, it's important they don't drink from an hour before taking desmopressin, until eight hours after. If your child drinks too much fluid during this time, it could cause a fluid overload, leading to unpleasant symptoms such as headache and sickness.
If your child isn't completely dry after one to two weeks of taking desmopressin, inform your GP because?the dosage may need to be increased.
Your childfs treatment should be reviewed after four weeks. If the bedwetting has improved, it's usually recommended that treatment continues for another three months, although your doctor may advise?taking desmopressin earlier each night (1-2 hours before bedtime). If there is continuing improvement during this time, the course may continue.
If bedwetting stops while taking desmopressin, the medication is reduced gradually to see if your child can stay?dry without taking it.
If?desmopressin or a bedwetting alarm doesn't work, you will be referred to a specialist.
Another option is to use a combination of desmopressin and an additional medication known as an anticholinergic. An anticholinergic called oxybutynin?can be?used to treat bedwetting.
Oxybutynin works by relaxing the muscles of the bladder, which?can help improve?its capacity and reduce the urge to pass urine during the night.
Side effects of oxybutynin include feeling sick, dry mouth, headache, constipation or diarrhoea. These should improve after a few days once your childfs body gets used to the medication. If they persist or get worse, contact the doctor?in charge of your childfs care for advice.
If the above?treatments don't work, a prescribed medication called imipramine may be recommended.
Imipramine also relaxes the muscles of the bladder, increasing its capacity and reducing the urge to urinate.
Side effects of imipramine include dizziness, dry mouth, headache, and increased appetite. These should improve once your childfs body gets used to the medication. It's important that your child doesn't suddenly stop taking imipramine because it can lead to withdrawal symptoms such as feeling and being sick, anxiety and difficulties sleeping (insomnia).
Treatment should?be reviewed after three months. Once it's felt your child no longer needs to take imipramine, the dosage can be gradually reduced before the medication is?stopped completely.
Advice for parents
It can be easy for experts to advise parents to remain calm and supportive if their child is bedwetting, but in reality it can be a difficult condition to live with.
While it's?important never to blame or punish your child, it's also perfectly normal to feel frustrated.
You should tell your GP if you feel you need support, particularly if you're finding it difficult to cope.
You may also find it useful to talk to other parents who have been affected by bedwetting. Education and Resources for Improving Childhood Continence (ERIC) has a message board for parents.
The?advice below may help you and your child cope better with bedwetting:
- Make sure your child has easy access to?the toilet at night. For example, if they have a bunk bed they should sleep on the bottom. You could also leave a light on in the bathroom and put a childfs seat on the toilet.
- Use waterproof covers on your childfs mattress and duvet. After a bedwetting, use cold water or mild bleach to rinse your childfs bedding and nightclothes before washing them as usual.
- Avoid waking your child in the night?or carrying them to the toilet, as these?are unlikely to help them in the long-term.
- Following a bedwetting, older children may want to change their bedding at night to minimise disruption and embarrassment, so?having clean bedding and nightclothes available for them can help.
- You can try taking off pull-ups at night, but this should be considered a trial rather than a treatment. If the child continues to bedwet, wearing pull-ups is often nicer for them and easier for the family to manage.
Complementary and alternative treatments
Some parents?consider using complementary and alternative?treatments - such as?hypnosis, psychotherapy, acupuncture?and chiropractic treatment?- to help with their child's bedwetting.
However, these treatments aren't usually recommended because there's only very weak evidence, or no evidence,?to support their use. Further research is necessary to determine how effective and safe they are for use with bedwetting.
Read more about complementary and alternative medicine.
Page last reviewed: 27/03/2015
Next review due: 27/03/2017