Bedwetting & toilet troubles

If one parent wet the bed as a child, the chance is about 1 in 3. If both did, it’s about 7 in 10. Bedwetting is also more common in boys.

A common reason is that the brain and bladder don’t communicate well yet, especially during deep sleep. Some children also make more urine at night.

Primary wetting is when a child has never regularly stayed dry. Secondary wetting begins after at least 6 months of staying dry.

In children who were dry before, new wetting can be linked to stress, trauma, illness or constipation. Rarely, it is a sign of a serious health problem, so it is worth a doctor’s visit.

Stress at home or school may play a part.

A new baby, a move, starting school, family changes or being bullied can all unsettle a child.

With bladder training, children go to the toilet on a schedule, about every 2 to 3 hours. This is called timed voiding. Some children also learn to go twice in one visit, or to relax the pelvic floor muscles.

Ideas that help

• A watch or gentle reminder for toilet breaks
• Taking extra time to relax and empty fully
• Using the toilet whenever they feel the urge, not holding on

Limiting caffeine, fizzy drinks, citrus juices and sports drinks can help, because they may irritate the bladder or make more urine. Drinking more water may help too, if the doctor recommends it.

Treating constipation can reduce pressure on the bladder that adds to wetting. Holding in poo can also lead to bladder control problems.

Reducing stressors, such as a new baby or a change of school, can help. A counselor or psychologist can help with anxiety. Parents should respond with support rather than blame or punishment.

Children most often get constipated from holding in poo to avoid or delay going. The poo then dries out and becomes hard and painful to pass, so they hold on even more.

Hard poo can build up and stretch the bowel, and softer poo can leak around it without the child feeling it coming. Children are usually not doing it on purpose.

Poo in underwear that looks like diarrhea can actually be a sign of constipation.

Common reasons

• Being embarrassed to use a public or school toilet
• Feeling stressed about potty training
• Not wanting to stop playing
• Remembering a painful poo and fearing another

Toileting problems can also be tied to big changes, like a new baby, a move or starting school. Over time, a child can start to avoid the toilet, which makes things worse.

Ideas

• A footstool so their knees are higher than their hips
• Plenty of water, fruit, vegetables and active play
• Praise sitting and trying, not just results
• See a pediatrician first to check for constipation or other health causes
• Set calm, regular toilet times, especially after meals
• Work with school on easy, private toilet access and a spare clothes kit

How it can feel

• Deep embarrassment and fear of being found out
• Feeling “broken” or different from other kids
• Hiding dirty underwear or wet sheets because they feel ashamed
• Teasing or being left out by classmates or siblings

Hiding is a sign of shame, not sneakiness. A calm reaction makes it easier for them to tell you next time.

Some children avoid sleepovers, camp or school trips because they are scared of wetting in front of others. Quiet planning can help them join in. See the “Sleepovers, camp and school” section.

Ideas

• Keep it private from siblings and visitors
• Let your child help change sheets if they like, but stop if it feels like a punishment
• Stop teasing, especially from brothers and sisters
• Tell them it isn’t their fault and that most children outgrow it

Daily routine

• Avoid caffeine, fizzy drinks, citrus juices and sports drinks
• Drink most liquids in the morning and early afternoon
• Go to the toilet every 2 to 3 hours in the day, about 4 to 7 times in total
• Go twice before bed, about half an hour apart

Make sure your child still drinks enough during the day. Cutting drinks too much is not the answer.

Ideas

• A night-light so the toilet is easy to reach
• Layered sheets so a wet layer can be pulled off quickly
• Waterproof mattress and duvet covers
• A daily bath or shower

Experts suggest avoiding nappies or pull-ups at night, except when away from home. Routinely waking a child to go at night is not recommended, because researchers don’t think it helps.

A sensor clips to clothing or bedding and senses the first drops of urine. The alarm wakes the child, who then goes to the toilet. Over time, many children learn to wake up when the bladder is full.

Families should use the alarm regularly for 3 to 4 months. Early progress, like smaller wet patches, often shows in the first few weeks. Alarms are successful 50% to 75% of the time.

Parents and children can agree on goals and small rewards, tracked on a calendar. Rewards are for effort, like going to the toilet before bed, not for dry nights alone. Shame and punishment are not recommended.

Pediatricians warn against “cure” programs or devices that may make false claims and can be expensive. If one approach doesn’t work, don’t give up. Some children respond to a mix of approaches.

Ideas

• A sleeping bag liner or discreet pull-up for nights away
• A quiet word with one trusted adult (with your child’s permission)
• A spare set of pajamas in a plastic bag
• Choosing a bed near the toilet
• Practicing the plan at home first

Pull-ups at night are generally best avoided at home, but can be useful when away from home.

What to ask school for

• A quiet signal to leave class without asking out loud
• A spare clothes kit kept with the school nurse
• Permission to use the toilet whenever needed
• Privacy: only staff who need to know are told
• Regular reminders for toilet breaks if bladder training

Some children avoid school toilets because they feel embarrassed. Ask whether a more private toilet is available.

Ideas

• Handle accidents quietly and matter-of-factly
• Never refuse a toilet request from a child you know has accidents
• Stop teasing quickly and firmly
• Work with the family and school nurse on a simple plan

Helpful words

• “It’s not your fault.”
• “Lots of kids your age wet the bed. You’re not the only one.”
• “Most children grow out of it.”
• “We’ll work on it together.”

Try to avoid

• Blaming the child
• Making it a big issue
• Punishing or shaming: it isn’t their fault and punishment can make it worse
• Telling others without their permission

Broken sleep, extra laundry and worry can wear any parent down. Feeling frustrated is normal. Take turns with another adult if you can, and remind yourself that this phase usually passes.

Wetting is almost never due to laziness. If one parent wet the bed as a child, their child’s chance is about 1 in 3. Punishment doesn’t help and can make it worse.

Routinely waking a child to go to the toilet at night is not recommended. Daytime habits, alarms and patience are more useful.

Children should drink enough through the day, with most drinks in the morning and early afternoon.

Children most often get constipated from holding in poo. When poo builds up, softer poo can leak without a child feeling it, so they are usually not doing it on purpose.

• Counselor or psychologist: worry, stress or big changes behind the wetting
• Pediatric urologist: if the doctor wants a specialist to check the bladder
• Pediatrician or family doctor: the first step for any wetting or poo worries
• School nurse: plans for school, trips and camp

In children who were dry before, new wetting can be linked to stress or trauma. Gently ask how things are going at school and at home.