Bed-wetting is really not a disease, but
a symptom. It is considered here, because it is a problem in
many families. At age two, about 40 percent of children wet
their beds at night. By age four and one half, 12 percent are
still bed-wetters, and by age eight , 7 percent. A few children
do not gain control of the bladder-emptying function until about age
Doubtless several factors cause the
problem of late bladder control. Some bed-wetting children sleep
very soundly part of the time, and this may interfere with the
development of the control pattern by which the brain overrules the
emptying reflex even during sleep. In some cases the bladder's
capacity does not increase in proportion to general body growth.
In an estimated 20 percent of cases, a
hindrance to free flow of urine exists somewhere between the bladder
and the outside. This may not hinder the emptying of the child's
bladder when he is awake, but it disturbs the functional balances
enough to cause bed-wetting at night. The hindrance may consist
of simple folds in the membrane that lines the urethra. It may
consist of a narrow place (stricture) along the course of the
urethra or of an unusually small opening at the external end of the
urethra. Diabetes, when present, causes the person to drink more
water and thus to have more urine to expel. Emotional problems
were formerly blamed for many cases of bed-wetting, but it is now
believed that bed-wetting of itself is not proof that a child is
Do not punish a child who wets the bed.
He does not do this intentionally. It is uncomfortable to him.
Be sympathetic and solicit his cooperation in overcoming the problem.
Establish a program to increase the bladder capacity. By
deliberately emptying the bladder less frequently during the daytime
the bladder stretches to accommodate a larger volume of urine, and
this stimulates its growth. To start the program, a chart must
be kept day by day, recording the time of day the child goes to the
toilet and the volume of urine passed each time. This requires
use of a measuring glass. After keeping the record for a few
days, the child is then encouraged to hold his urine as long as
possible after he has the urge to void. Praise him each time he
holds his urine a little longer and each time he voids a larger
Do not restrict the water the child
drinks during the day. But it is well for him to drink very
little water, if any, after his evening meal. He should not be
criticized when he still wets the bed occasionally. However, the
bed-wetting should become less frequent as the program proceeds.
Praise the child when he remains dry all night. This program of
increasing the bladder's capacity may need to last as long as six
If the above program does not give good
results, take the child to a urologist, who will advise on whether
simple surgery (such as dilating the urethra) may relieve the problem.
Urologists also use the drug imipramine (Tofranil) in the treatment of