Bedwetting after age 5: causes, what helps, and when to treat

Why it happens

Night dryness needs three things to line up: a bladder big enough for the night, a nighttime rise in the hormone that concentrates urine, and the ability to wake when the bladder is full. Any of them can lag, and they lag in families: if one parent wet the bed, a child has about a 45% chance; if both, about 75%. Deep sleepers wet more. Constipation is a frequent, fixable contributor because a full rectum presses on the bladder.

What helps at home

• Normal drinking through the day, less in the two hours before bed, and no caffeine
• Urinate twice before bed: once at the start of the routine, once at lights out
• Treat constipation: soft daily stools change everything
• Waterproof mattress cover, a spare set of sheets and pajamas within reach, and a calm “let’s change the bed” routine
• Involve your child in the cleanup without blame
• No pull-ups after 5 or 6 if you are working on dryness; they feel too much like a diaper

Treatment

When a child is 6 or 7, bothered by wetting, and motivated, a bedwetting alarm is the treatment with lasting results: a sensor in the underwear sounds at the first drop, and over 6 to 12 weeks the brain learns to wake or hold. It needs parents to help the child wake at first. Desmopressin, a tablet that reduces nighttime urine, works the same night and is useful for sleepovers and camps, but wetting returns when it stops. We discuss both at a visit.

Protecting self-esteem

Bedwetting is embarrassing, and children who are punished or teased do worse. Say plainly that it is not their fault, that many children in their class have it, and that it will stop. Siblings are not allowed to mention it.