Bed Wetting

My seven year old son has never been dry at night. My friend says he must have some emotional problem and I should take him to counseling. His father wet the bed until he was 9 or 10 years old. Could there be a genetic link? Should I take my son to counseling or is there other treatment? It’s becoming a real problem for the entire family and I don’t know what to do.
Fresno, California

Bed Wetting

Dr. Greene’s Answer:

Contrary to popular opinion, bed-wetting is a very common problem. It affects somewhere between five and six million children. Unfortunately, most of those kids and their parents feel that something must be emotionally wrong; that they must be suffering from low self-esteem, trauma, or stress in their lives. The great news is that, in the vast majority of cases, this is not true!

Bed-wetting, or nocturnal enuresis, can be divided into two types: primary nocturnal enuresis and secondary nocturnal enuresis. These two types are very different in their causes and treatments.

In primary nocturnal enuresis, children have never achieved complete nighttime control – always wetting at least two times a month. Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.

In secondary enuresis, the key is finding out exactly what has changed. There might be a new psychological stress such as a divorce, a move, or a death in the family. It might be something physical: the onset of a urinary tract infection or diabetes, for example. It might be a situational change – perhaps altered eating, drinking, or sleeping habits. Clearly, something has changed. The first step in solving the problem is identifying that something.

The great majority of bed-wetting children are primary enuretics. For primary enuretics, the cause is decidedly NOT stress or behavioral concerns. Research has shown that primary nocturnal enuresis is often inherited. If both parents were bed-wetters, 77% of their children will be. If only one parent was, 44% of their offspring will be. If neither parent wet the bed, only about 15% of their children will wet the bed. With primary nocturnal enuresis, one almost always finds another relative who was a bed wetter. This corresponds to what is called an autosomal dominant inheritance pattern.

In recent years, researchers have identified an association with bedwetting and two genes named ENUR1 and ENUR2. The ENUR1 gene is located on the 13th chromosome while ENUR2 is found on chromosome 12. In studying certain families with primary nocturnal enuresis, researchers discovered that members who wet the bed were more likely to have the ENUR1 or ENUR2 gene than those who did not. More recently, the possibility of a third primary nocturnal enuresis-related gene (ENUR3) on chromosome 22 has also been uncovered. Presumably these genes affect either whether children will need to urinate at night or how easily they can wake up when their bladders are full.

If your child has primary nocturnal enuresis, I would not take the child to counseling to solve the problem. Beginning at age seven, primary nocturnal enuresis resolves on its own at a rate of 15% per year. It is quite likely that if nothing were done, your child would wet the bed until about the same age as his father. There is no reason to wait until age nine, since effective and safe therapies are now available. The best way to pursue help is to talk with your pediatrician. If you find that for some reason she or he is not able to get your child dry quickly and effectively, I would call the closest Children’s Hospital to find out who treats bed-wetting issues.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Steve Miller

    Many pediatrians will recommend a choice of either bedwetting alarms, medications, both or waiting it out.
    Your doctor knows best. If they recommend bedwetting alarms, you have choices. We got ours at http://onestopbedwetting.com
    The selection is large and they have helpful staff members to guide you through the process.

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  2. maureen

    What if you have tried an alarm and you’ve been doing the alarm for over 9 months? We have made progress in that he now wakes up when he hears the alarm and gets himself to the restroom. Usually its just his underwear that is wet but sometimes its the bed. Do we just keep at it? He’s fine with it to some extent but he is concerned about his friends finding out.

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    • maureen

      He is 8 1/2 years old.

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    • I would love to hear the response from other parents who’ve worked with alarms. What do you think?

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  3. Sophie

    I am dating a man who has a 13 year old son who wets the bed still. He has been to an urologist several years ago. He was told that he would grow out of it, but it is still persistent and happens several times per week. I grew up with both a sister and a brother who wet the bed regularly and my parents got them the sensor things to help wake them up. I was wondering if this is a viable option? My biggest hope for this boy is that he can start living like a kid who should have friends over and go over to friends houses. He consistently makes excuses for not going to camps and other outings and it breaks my heart. My boyfriend moved his elderly mother in with him recently and while the 13 year old was doing his homework the rest of us went outside to do some yard work. I went back into the house for some waters and he was in tears and I could hear grandma berating him from the next room. I worry about his state and after I got him out of the house I lit into grandma but I know there are ways to help him and I would love to do so without further embarrassing him. What options are available for an older child and what is the best way to approach him without embarrassing him further? I am after all just dads girlfriend.

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    • Hello Sophie,

      You are indeed in a tough spot as dad’s girlfriend. Likely it would be best for you to make suggestions to your boyfriend and let him introduce those ideas to his son and the rest of the family.

      While a majority of kids do grow out of bed wetting, at 13, it’s time for another evaluation. The doctor may decide it’s time for medication that can help.

      There are also alarms that can help train the brain to wake up when the bladder gets full. These do not require a doctor’s prescription. Most of these alarms are very loud and wake everyone in the house — except the person who is wetting the bed. The reason? Bed wetters tend to be very, very deep sleepers. With an older child these alarms can add to the embarrassment. There are alarms that vibrate instead of sounding loudly. They are good for older kids, but may not work as well as the loud alarms.

      With any alarm, it typically take 3 months before you see real results. It is tempting to give up long before that time. If the family has a “we’ll try this few nights to see if it works” attitude, it likely won’t work before they give up.

      You are right that your boyfriend’s son deserve’s a kid’s life. I hope you’ll be successful in helping him achieve dry nights.

      Best,
      @MsGreene

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      • Sophie

        Thanks for the encouragement. I have talked to my boyfriend about it and we are going to look more into this weekend and dad is going to talk with his son one on one to see what he wants to do. I am hopeful that we can get him dry. He really wants it himself and has tried completely changing his diet on his own with no results. Poor kid is very discouraged over everything.

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        • Glad to hear action is pending. We’d love for you to keep us informed. Feel free to ask follow-up questions, too.

          Best,
          @MsGreene

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  4. katie

    My daughter (5) has never been consistently dry….me nor my husband can remember being bedwetters…..but my dad wet the bed until he was 12. When you say you almost always find a relative who was a bed wetter….does a grandarent count?

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