Bed-Wetting (Enuresis)

What is enuresis?

Enuresis (bed-wetting) is the term used for the involuntary passage of urine during sleep. It is a very common problem that affects 10% of 6-year-olds, 5% of 10-year-olds, 3% of 12-year-olds, and 1% of 18-year-olds.

What is the cause?

Most teens with enuresis have inherited a small bladder, which cannot hold all the urine produced during a night. Measure your bladder size to see what you have to overcome. (Normal teen size is 12 to 16 ounces of urine.) In addition, teens are deep sleepers who don't awaken to the signal of a full bladder. If they did, they wouldn't be wet. Physical causes are very rare and your health care provider can easily detect them. Emotional problems do not cause enuresis, but they can occur if it is mishandled.

How long does it last?

Even without treatment, all children and teens eventually get over their bed-wetting, but it may take years. With treatment, you can become dry much sooner. Using the following suggestions, most teenagers can learn to use the toilet during the night.

What can I do to stop wetting the bed?

1. Your goal is to wake up every night and use the toilet. Teens with small bladders cannot stay dry unless they get up to urinate one or more times every night. Getting up can keep you dry regardless of how small your bladder is or how much you drink. You will not be cured completely until you learn how to do this.
2. Decrease evening fluids. Normal fluid intake is fine, but try not to drink excessive fluids during the 2 hours before bedtime. Especially avoid beverages that contain caffeine because caffeine increases urine production. Remember: Everything you drink eventually becomes urine. During the day, however, drink all you want.
3. Empty your bladder at bedtime. Start the night with an empty bladder. Put up a sign if you have trouble remembering to do this.
4. Bedtime pep-talk about self-awakening. To help awaken yourself at night, practice the following routine at bedtime:
   • Lie on your bed with your eyes closed.
   • Pretend it's the middle of the night.
   • Pretend your bladder is full.
   • Pretend you feel the pressure.
   • Pretend your bladder is trying to wake you up.
   • Pretend your bladder is saying, "Get up before it's too late."
   • Then run to the bathroom and empty your bladder.
   • Remind yourself to get up like this during the night.
   • If you think of a better way to remind your brain to get you up every night, do it and you'll be dry.
5. Daytime practice of self-awakening. Whenever you have an urge to urinate and you're home, go to your bedroom rather than the bathroom. Lie down and pretend you're sleeping. Tell yourself this is how your bladder feels during the night when it tries to awaken you. After a few minutes, go to the bathroom and urinate (just as you should at night).
6. Bed-wetting alarms. Alarms are used to teach you to awaken when you need to urinate during the night. They go off when they become wet. One type awakens you with a loud noise (buzzer), the other type with an annoying vibration. They have the highest cure rate (about 70%) of any available approach. They are the treatment of choice for any bed-wetter with a small bladder who can't otherwise train himself to self-awaken at night. The new transistorized alarms are small, lightweight, sensitive to a few drops of urine, not too expensive (about $50), and easy for a teenager to set up by himself. Teens using alarms still need to work on the self-awakening program.

   See also Bed-Wetting Alarms

7. Alarm clock. If you are unable to awaken yourself at night and you can't afford a bed-wetting alarm, use an alarm clock or clock radio. Set it for 3 or 4 hours after you go to bed. Put it beyond your arm's reach. Practice responding to the alarm during the day while lying on the bed with your eyes closed. Set the alarm each night.
8. Parent-awakening. If self-awakening fails, don't give up hope. Ask your parents to help you learn how to awaken. Your parents' job is to wake you up; your job is to locate your bathroom and use the toilet. Your parents can awaken you at their bedtime. Your parent can try a hierarchy of prompts (the minimal one being the best), ranging from turning on a light, saying your name, touching you, shaking you, or turning on an alarm clock. If you are confused and very hard to awaken, your parent can try again in 20 minutes. Once you're awake, you need to find the bathroom without any directions or guidance. If you awaken quickly to sound or touch for 7 consecutive nights, you're either cured or ready for an enuresis alarm.
9. Change wet clothes during the night. If you are wet at night, try to get up and change yourself. First, if you feel any urine leaking out, try to close the bladder's valve and stop the flow of urine. Second, hurry to the toilet to see if you have any urine left in your bladder. Third, change yourself and put a dry towel over the wet part of the bed. (This step can be made easier if you always keep dry pajamas and towels on a chair near the bed.) If you are able to carry out these steps, you are close to being able to awaken from the sensation of a full bladder.
10. Establish a morning routine for wet pajamas and wet bedding. On wet mornings, rinse your pajamas and underwear in the sink until the odor is gone. To make sure you smell good, take a quick rinse in the shower. You can cut down on the laundry by placing a dry towel under your bottom each night. The towel can also be rinsed in the morning. If a wet bed is left open to the air, the wet sheets will usually be dry by noon. Because of odor, the sheets may need to be washed a few times each week.
11. Medicine. Most bed-wetters need extra help with staying dry during slumber parties, camping trips, vacations, or other overnights. Some take an alarm clock with them and stay dry by awakening once at night. Some are helped by temporarily taking a drug at bedtime. One drug decreases urine production at night and is quite safe. Another temporarily increases bladder capacity. It is safe at the correct dosage, but dangerous if too much is taken or a younger sibling gets into it.

    If you do use a medication, be careful about the amount you use and where you store the medicine, and be sure to keep the safety cap on the bottle. The drawback of these medicines is that when they are stopped, the bed-wetting usually returns. They do not cure bed-wetting. Therefore, teenagers using drugs for enuresis should also be using an alarm and learning to get up at night.

When should I call my health care provider?

Call during office hours if:

• Urination causes pain or burning.
• The stream of urine is weak or dribbly.
• You also have wetting during the daytime.
• Bed-wetting is a new problem (you used to stay dry).
• You are not better after 3 months of following this treatment program.