Dr Catherine
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4-7 years

Dear Paula, managing children’s bedwetting can be incredibly tricky, partily because we often do not understand the underlying cause and partly because there are so many mixed messages out there about how best to proceed. It is often helpful to keep in mind nighttime wetting is mostly unconscious and therefore the kinds of techniques we used in training children during the day do not apply to the nighttime situation. Nighttime wetting at this age is considered to be perfectly normal, with about 15-20% of children continuing to wet at night up to the age of 7 years. Medical causes are rare and only account for approximately 10% of all bedwetting cases. It is however very important to rule this out first. The three most common causes of bedwetting include (1) an overproduction of urine overnight – children who have low-levels of ADH (antidiuretic hormone) produce four times the amount of urine as those who have the hormone and are therefore at a greater likelihood of exceeding their bladder capacity overnight. If this is the cause children generally stop wetting their bed when their ADH levels return to normal; (2) Difficulty arousing from sleep in response to a full-bladder – these children are unable to detect the signals sent from their bladder to their brain telling it it is full and needs emptying. These children will stop wetting when their body matures to a point where they can wake-up in response to their full bladder; and (3) a genetic disposition – children who wet the bed are more likely to have a family member who also wet the bed as a child. The cause of a child’s bedwetting will often inform how best to progress when it comes to treatment, although it is important to keep in mind that not all cases of bedwetting have an identifiable cause. If you have not done so already, I would recommend making an appointment with a doctor who specialises in treating nighttime incontinence as he or she will be best placed to help determine the possible underlying cause. All the best! Regards, Dr Cathrine