According to the American Academy of Pediatrics (AAP), an estimated five million children in the U.S. wet the bed. Bedwetting is more common with younger kids, but as many as ten percent of seven-year-olds and five percent of ten-year-olds may wet the bed. It’s more common for boys to do so than girls.
Regardless of age, rest assured that your bedwetting child is not choosing to do this and is not just being lazy. There are reasons for bedwetting. It’s important not to blame or punish your child for bedwetting incidents. It’s better to learn — along with your child — possible causes of the bedwetting and ways to overcome it.
What Can Cause Bedwetting
The AAP suggests that causes of bedwetting include:
* Deep sleep that delays waking for a full bladder.
* Inability to hold and empty urine throughout the day.
* Constipation, which puts pressure on the bladder.
* Small, unable-to-hold urine for a full night.
* Family history or underlying medical issue.
Recently, pediatric urology specialists have suggested that another possible cause of bedwetting is “pee-holding.” This is when kids hold their urine and tire their bladder. Then at night, when sleeping, the pelvic floor — the muscles used in holding — relax and the urine is released.
Often kids urinate more than once at night because they have not urinated the typical six-to-eight times necessary during awake hours. The same effect could come from “poop-holding” because a large amount of stool in the rectum takes up space in the pelvic area, which squishes the bladder, causing it to contract and not hold urine throughout the night.
These two issues almost always occur simultaneously. And they both can cause what can commonly be referred to as a “small bladder.” It is important to know that the bladder can be functionally small due to daytime holding of urine and stool. These actions can tire the bladder so that it can’t hold urine at night, even though it is a completely normal-sized bladder.
Bathroom Breaks Matter
A great question to ask your school-age children — whether they have any urine or stool issues or not — is what the rules are for going to the bathroom at school, posing it as an open-ended question. The answers that they give can be very revealing about their stool and urine patterns at school.
It’s also important to note that the more you hold stool and urine, the “better you get at the holding,” meaning that this can lead to actually feeling as though you don’t need to go.
To overcome these holding issues, make sure your children have adequate opportunities to use the restroom throughout the day and evening, especially during school or after-school activities. Become a bathroom-break advocate, if necessary. Teach your kids the importance of going to the bathroom when they feel the urge. Along these same lines, don’t ask your children if they need to go to the bathroom, as the answer will almost always be “no!” Instead, build bathroom breaks into the day so that they learn to go six-to-eight times regularly.
Water intake is also very important to elimination health. A good guideline is for your child to drink half of his body weight in ounces of water, i.e., a 50-pound child would drink 25 ounces of water a day, preferably throughout the day between breakfast and dinner.
If bedwetting is negatively affecting your child — mentally or physically — speak with your pediatric healthcare provider to discuss the best course of action for your child’s situation. Reassurance that your child will grow out of it is not enough, and effective treatments are available.
MiChelle McGarry, MSN, RN, CPNP, CUNP, FAANP, is a pediatric and urology nurse practitioner who has practiced pediatric urology since 1999 and successfully treated thousands of patients with bowel and bladder dysfunction, including bedwetting. She is the director at the Pediatric Effective Elimination Program (PEEP) Clinic & Consulting PC in Denver.