Managing bedwetting starts with understanding what causes bedwetting. There are many possible causes, although in truth, most of the causes are mysterious. The good news is that in most cases it’s not necessary to know the true cause, because so much bedwetting is “functional“, which is to say that it ‘just happens’ in a perfectly normally functioning child! Most functional bedwetting goes away on its own without any intervention.
What Causes Bedwetting
- Heredity – If either parent wet the bed as a child, there’s about a 50% chance his child will too. The chances jump to almost 75% if both parents were wetters. We assume from this fact that there is some genetics involved in bedwetting, but that’s about all we can say. There is no identified gene for bedwetting!
- Immature Bladder – In order to stay dry through the night, a child needs to feel when her bladder is full, and respond by getting up and going to void, hopefully in the toilet. In some children, this sequence of full bladder-signal to the brain-go to the bathroom is not fully developed until later ages. In some children, the issue may be a hormone called Antidiuretic Hormone (ADH). Children with low ADH fill their bladders more quickly than others and have to pee more often. There’s no specific treatment for this. It gets better on its own with time.
- Small Bladder Capacity – When people complain that they have the bladder the size of a walnut, sometimes they are not far off. Some children have smaller than normal bladders. Others have normal sized bladders that simply “feel full” and begin to try to empty before they are truly full.
- Sleep Stage Problem – Many parents have told me that they believe their children wet the bed because they “just sleep so deeply!” Some of these parents are right… partially. It’s true that children get into much deeper Stage IV sleep than adults do. These children often do not arouse fully from sleep and instead enter a half-sleep-half-awake state in which they might wet the bed. These are also the children who sleep walk and sleep talk. This tends to improve between ages 7-18, about the time that bedwetting goes away.
- Emotional Factors – These factors are not clearly defined, but certain psychological stressors can lead to bedwetting in some children. These most often occur in secondary bedwetting, that is, bedwetting that begins in a child who had been previously dry for long periods.
- Environment/Early Childhood Experience – Richard Ferber refers to studies in which lower income children, middle children, and children faced with early stresses such as divorce tend to wet the bed longer than other children. These stressors do not always cause bedwetting. The contribution of these environmental factors is very small, however. Ferber advises parents not to blame themselves for their child’s bedwetting. Chances are environment had very little to do with it.
- Medical Factors – There are a fair number of medical problems that can lead to bedwetting. That’s why it’s important to see your pediatrician before you try to solve your child’s bedwetting problem. If the medical problems are addressed, the bedwetting problem is taken care of!
- Urinary Tract Infections: This is a fairly common cause of bedwetting. Some young girls will wet their underwear during the day as well when they have a UTI.
- Diabetes: As with UTIs, Type I diabetes is a cause of secondary bedwetting. This is why it’s especially important to see a doctor for a previously-dry child who starts wetting the bed.
- Neurological Problems – Most of these problems are already known to parents and doctors before the issue of bedwetting is ever addressed. This is because these neurological problems are usually present at birth, such as spinal cord defects. Occasionally, however, such problems are not known until the child “presents” with primary bedwetting!
- Other Sleep Problems – Many children with obstructive sleep apnea (OSA) wet the bed. The reason may have to do with the fact that children with OSA do not have a normal expected sleep pattern. They cannot achieve deep levels of sleep, or stay in them long, because they must arouse themselves frequently to keep breathing!
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Once the possible medical causes are ruled out, the parents and the child can set out on the sometimes long, sometimes difficult, but always rewarding path to staying dry during the night. We will address management of bedwetting in a future post.