Bedwetting – Diagnosis and Treatment

Diagnosis

To figure out why a child has enuresis, a doctor often uses a mix of exams and tests. The process may include:

• Physical Exam: Checks for signs of health problems.
• Discussion: The doctor asks about symptoms, fluid intake, family history, and how bedwetting affects daily life.
• Urine Tests: Help find urinary tract infections, diabetes, or other issues.
• Imaging: Sometimes, doctors use x-rays or scans to view kidney and bladder structures.
• Extra Tests: Doctors may use these to find other causes, like overactive bladder, ADHD, or developmental delays.

A table below shows what doctors may look for:

Exam or Test	Possible Discovery
Urinalysis	Infections, diabetes
Imaging	Issues in kidney/bladder
Detailed History	Secondary enuresis, family links, habits
Extra Tests	ADHD, overactive bladder, encopresis

Treatment

Bedwetting Alert Devices

Bedwetting alert devices help children become aware when they start to urinate during sleep. These devices usually include a sensor attached to the child’s sleepwear or sheets that detects moisture.

Once wetness is sensed, the device sets off an alarm—either a sound or vibration.

• How It Works: When a child begins to wet the bed, the alarm quickly signals them or a caregiver. This allows the child to wake up, pause urination, and use the toilet. For children who sleep deeply, adults may need to help them wake up when the alarm sounds.

• Tips for Use:
  • Use the device consistently each night.
  • It can take several weeks or months—sometimes up to four months—for the child to stay dry overnight.
  • Caregivers should be patient and support the child.
• Benefits:
  • Bedwetting alarms are not invasive and have a very low risk of side effects.
  • Research shows many children get long-lasting results using these alarms.
  • Unlike medications, this method aims to change the body’s response for the long term.

Moisture Alarm Device	Feature	Notes
Type	Sound or vibration	Can suit different needs
Power	Battery-operated	Easy to set up
Placement	Pajamas or bedding	Sensor pads available
Insurance	Not always covered	Check before buying

Medication Options

When lifestyle changes and alert devices do not stop bedwetting, doctors may suggest medicine for short-term help. Medicine does not cure bedwetting, but it may reduce nighttime accidents while it’s being used.

• Reducing Nighttime Urine: Desmopressin (often called DDAVP or desmopressin acetate) is a medicine similar to vasopressin—the body’s antidiuretic hormone (ADH). It decreases how much urine the body makes at night. Desmopressin comes as an oral pill and is only for children at least 6 years old. Children taking desmopressin must avoid drinking too much liquid, especially if they are sick with vomiting or diarrhea.

• Bladder Relaxants: If an overactive or small bladder is part of the problem, doctors may prescribe an anticholinergic. These drugs help the bladder relax and hold more urine. Sometimes, doctors use anticholinergic medicine together with desmopressin or other drugs if one alone is not enough.

• Other Medication Options: In some cases, doctors use older medicines like tricyclic antidepressants. However, these are usually only considered if newer options do not work, as they may have more side effects.

Important Notes:

• Doctors usually reserve medicine for cases when other strategies do not work or when a child is very anxious about accidents.
• Results often last only as long as the medicine is taken—bedwetting usually returns if treatment stops.
• Health care providers should supervise any medicine for bedwetting to watch for side effects.

Key Tips:

• Work with a health professional to choose the right path.
• Never use nasal spray forms of desmopressin for bedwetting, as they are not considered safe for this purpose.
• Follow all instructions carefully to manage risks and help stop bedwetting as safely as possible.

Ways to Manage Bed-Wetting at Home

Making small changes at home can support better bladder control and reduce bed-wetting. Limiting drinks in the last two hours before bed helps many children, but it is still important for them to stay hydrated earlier in the day.

Children who have after-school activities may need fluids later, so exceptions can be made when needed.

Foods and drinks with caffeine, such as soda, chocolate, and tea, should be avoided—especially in the evening—because caffeine can make the bladder more active.

Double voiding, or using the toilet twice before going to sleep, is another method that can help. This may involve using the bathroom once at the start of the bedtime routine and then again just before falling asleep.

Encourage regular toilet visits throughout the day, about every 2 to 3 hours. This helps train the bladder and can lower feelings of urgency.

Keeping a regular bathroom schedule can also support toilet training and improve both bladder and bowel control.

Children may also face rashes or skin irritation from wet underwear. Gentle cleaning each morning and using a moisture barrier cream at bedtime can protect the skin.

Night lights between the bedroom and bathroom can make it easier and safer for children to use the toilet during the night.

Here is a simple overview:

Change to Try	Why It Helps
Limit evening drinks	Reduces urine at night.
Avoid caffeine	Prevents bladder stimulation.
Double void before bed	Empties bladder more completely.
Regular daytime bathroom use	Improves bladder habits and training.
Night lights	Makes nighttime bathroom trips easier.
Skin care routine	Prevents irritation from wetness.

Other Ways to Manage Bed-Wetting

Some families look for different ways to manage bed-wetting outside of typical medical treatments. These methods are known as alternative or complementary practices.

They include therapies such as acupuncture, chiropractic care, herbal remedies, hypnosis, and biofeedback.

Alternative Method	What It Involves	Evidence of Effectiveness
Acupuncture	Small needles in the skin	Weak and not proven
Chiropractic Care	Spine and joint adjustments	No strong evidence
Herbal Remedies	Plants or extracts	Not proven effective
Hypnosis	Relaxation and suggestions	Little to no real evidence
Biofeedback	Training body awareness	Not enough research

People should always talk with a healthcare provider before starting any of these therapies. Check if the method is safe and that it does not interfere with other treatments or medicines.

Coping and Support Tips

Helping a child manage bed-wetting takes patience and understanding. Families play a key role in making this process easier. The way parents or caregivers react can strongly affect the child’s confidence and self-esteem.

Building a Supportive Environment:

• Encourage open talks about feelings. Letting children express stress or worries can help reduce tension.
• Stay calm and use positive words. Avoid blame or punishment, as bed-wetting is not something a child can control.
• Use gentle support when accidents happen. Praise following bedtime routines and cleaning up, instead of focusing only on dry nights.

Making Nights Easier:

• Use a table like the one below to organize cleanup supplies for busy nights.

Needed Items	Purpose
Plastic mattress cover	Protects the mattress from moisture.
Spare bedding	Easy replacement during nighttime changes.
Absorbent underwear	Helps with nighttime leaks, short-term only.
Extra pajamas	Quick changes after an accident.

• Involve the child, if old enough, by having them help with simple cleanup steps.

Handling Social Pressures:

• Discourage siblings or friends from teasing about bed-wetting.
• Remind the child that many others face this challenge and that it often goes away with time.

Boosting Self-Esteem:

• Create a sticker chart or give simple praise for following routines and being responsible.
• Emphasize successes, not failures. Avoid making dry nights the main focus of rewards.

Getting Ready for Your Visit

Steps to Take Before the Appointment

To make the most of your child’s healthcare visit, prepare some details ahead of time. Write down any symptoms your child has. These could include things like wet nights, changes in urine habits, or things that may not seem related.

Use a table or diary to track your child’s bathroom trips, waking times, and nights when they stay dry to provide clear information.

Date	Bedtime Bathroom Visit	Night Wet/Dry	Drinks After Dinner	Urgency to Urinate?
May 1	Yes	Wet	1 cup	Yes
May 2	Yes	Dry	None	No
…	…	…	…	…

Think about your child’s daily routines and any recent stress or big changes in their life. Write down any personal or family history of bed-wetting, such as if parents or siblings have had this issue.

List all the medicines, vitamins, or supplements your child takes, along with the doses. Be ready to share these details with the healthcare provider.

Take some time to consider any questions you want to ask. These may include:

• What could be causing my child’s bed-wetting?
• How long might this last?
• What treatment choices are there? Are there side effects?
• Are there different options?
• Should our family change drinking habits, like limiting fluids before bed?

Bring this list and your diary or notes to the appointment. You may also want to bring a loved one for support or to help remember information.

Questions Your Healthcare Provider Might Ask

The healthcare provider will likely ask specific questions to understand your child’s situation. These may include:

• Has anyone in the family had bed-wetting?
• Did the bed-wetting start recently or has it been ongoing?
• How often does your child wet the bed?
• Are there long periods when your child stays dry?
• Does your child stay dry during the day?
• Are there any stool accidents?
• Does your child ever say it hurts to urinate or feel any other symptoms?
• Are there any recent changes or stresses in your child’s life?
• If your child lives in two homes, does bedwetting happen in both places?
• How do you handle your child’s bedwetting at home?

If you prepare clear and honest answers, you can help the provider better support your child and have more time to discuss any other concerns or questions.