Are any tests needed? If your child seems healthy apart from the bedwetting, it is very unlikely that there is a serious cause. The only necessary test is a urine check. Your doctor will send a sample to the laboratory to check for infection and will also do a simple dipstick test to make sure the urine is not abnormal in any other way.
Bedwetting alarms (enuresis alarms) are suitable for children older than 5 years. They ring or buzz when your child begins to wet the bed. These are the most effective treatment. They wake the child, and this gets him or her into the habit of waking up when urine needs to be passed. There are two main types of alarm. You can either buy them (usually the case in the USA), or your health care provider can arrange for you to borrow one. Even if you decide to buy one, it is important that the practice nurse shows you how to use it properly. Using an alarm requires lots of patience and commitment from you but is worthwhile. There are two main types of alarm.
- Pad and bell alarms have a plastic mat that you put into the middle of the bed, where wetness usually occurs. The mat has an electrical circuit within it that is connected by a flex to a bell or buzzer alarm. You place the alarm out of reach so that your child has to get out of bed to switch it off, and then go to the toilet.
- Mini-alarms are neater. They clip onto the child’s nightwear, near the collar. A thin flex connects the alarm to the sensor, which you attach to the underpants. Wetness activates the alarm. It can be switched off temporarily, but the child has to change into dry clothes to prevent it going off again.
Using a bedwetting alarm:
- Don’t start using an alarm when some significant or stressful event is happening in the family (such as a new baby).
- For at least the first 10 nights, you will probably have to wake your child when you hear the alarm, so that he or she can switch it off and go to the toilet. You will need to help your child change the sheets and reset the alarm. Any ‘alarm’ system (e.g. baby alarm) will help you to hear the bedwetting alarm when it goes off.
- After about 10 days, many children will have learned to wake up promptly to ‘beat the buzzer’, so there will be a smaller wet patch. This is progress, so tell your child how pleased you are.
- If your child does not wake with the alarm, make it louder by placing the sound box in a tin.
- Be patient. Some children become dry after about 2 months of using the alarm, but many need 4 months.
- If your child becomes completely dry using the alarm, carry on using it for a further month.
- Bedwetting alarms do not work for all children. The success rate is about 70%. If after about 6 weeks, there is no progress at all (such as a smaller wet patch, or the alarm going off later in the night), it is best to stop using it, and try again after a few months.
- Although about 70% of children become dry while using the alarm, some start bedwetting again when they stop using it. A study found that 45% of children who had alarms remained dry afterwards (Drug and Therapeutics Bulletin 2004;42:33–37).
Medicines for bedwetting can be very helpful, but they do not really cure the problem. When the child stops taking them, bedwetting often occurs again. But they are a useful stopgap, for example, to use during a school trip. Also, if your child has to wake many times during the night to go to the toilet, their sleep is being disturbed, and this may affect their concentration and behaviour during the day; taking medicines can help to achieve a better night’s sleep. You require a doctor’s prescription for these medicines. We do not recommend prescribing to children under 10 years.
- Desmopressin helps the kidneys make less urine. It can be taken as tablets, a nose spray or a sublingual (under the tongue) wafer (‘melt’). On average, taking desmopressin gives 2 dry nights a week, and about one-third of children will be completely dry. It should be used for only a few months, then stopped to see if it is still needed. Because it works straight away, it is useful for special occasions. If it does not work during the first few nights, there is no point in persisting with it.
- Oxybutynin and tolterodine are medications that calm overactive bladder muscle. Either may be helpful if your child has daytime wetting (urinary incontinence) as well as bedwetting and has to rush to get to the toilet (urgency). These medications can cause side effects (dry mouth, constipation, blurred vision), but these are minimized by taking the medication at night. It can take a few weeks for these treatments to have maximum effect. Usually, they are stopped after 3-4 months to see if they are still needed.
- Imipramine is a medication that somehow helps the bladder hold more urine. On average, taking imipramine gives 1–2 dry nights a week. It used to be popular but is not used much now. It has some side effects and is very dangerous if too much is taken. It is not as effective as desmopressin.
First published on: embarrassingproblems.com
Reviewed and edited by: Diane Newman
Last updated: May 2021