Bedwetting perennially drives parents to the pediatric urology clinic at Johns Hopkins Children’s Center, but September — and the start of the school year — always brings a predictable uptick in visits, according to pediatric urologist Ming-Hsien Wang, M.D.

“Back to school is a physically and emotionally stressful time for many children, compounded by the sudden change in sleep patterns and schedules that generally wreak havoc on eating and other routines established over the summer,” Wang says.

Children who experience back-to-school flare-ups should stick to a regular “pee” schedule through the day, says Wang, who likes to send parents home with a note to their child’s teacher verifying the child’s urologic condition and recommending bathroom visits every two or so hours. The brain controls the bladder, Wang explains, so establishing a clockwork potty routine during the day helps improve brain-bladder communication in general.

Bladder control develops gradually in children, with nighttime bladder control, the final stage of the process, reached generally by age 6 or 7. A small number of children continue to wet their beds until age 10 and beyond.

Physical and emotional stressors are well-known contributors to both night-time enuresis and daytime incontinence in children, says Wang, and the vast majority of cases are due not to anatomical or biological problems, but to lifestyle issues such as lack of regular potty times, good hydration and appropriate diets.

“Changes in lifestyle take care of 80 percent of these problems,” says Wang, who only rarely prescribes drugs, which can have side effects, or bedwetting alarms, which disrupt the sleep cycles of both the child and the family.

She advises:

• Ruling out medical conditions that cause incontinence, including diabetes, urinary tract infections and kidney disease, as well as certain anatomic abnormalities of the genitourinary tract and some neurological disorders that affect brain-bladder signaling
• Letting your child know that this is a fixable condition and providing lots of emotional support
• Eating a diet rich in fiber with plenty of raw fruits and vegetables every day
• Drinking plenty of water to ease urination: The marker of good hydration is urine color, which should be pale yellow or as clear as water
• Send your child to school with a bottle of water (flavored, if necessary, with a bit of honey or lemon juice) rather than sugar-rich drinks
• Stopping fluids about three hours before bedtime
• Emptying the bladder immediately before going to bed
• Keeping a toileting diary for several days before the visit to the doctor and writing down how often a child empties the bladder, along with the number of daytime and nighttime accidents
• Although bedwetting can increase around back-to-school time, Wang says, the condition appears to be on the rise year-round.

“Anecdotally, we are seeing more and more patients referred to us by general pediatricians,” says Wang.

While experts have yet to verify the increase scientifically or tease out the factors behind it, Wang believes that more awareness of the condition, combined with lifestyle choices are the two main drivers.

Poor nutrition and eating and voiding habits are major contributors, Wang says, and children with constipation are also prone to bedwetting because both interfere with control of the pelvic muscles involved in toileting.

“When children cannot move their bowels, they also tend to hold their urine, which in turn makes them more likely to have accidents.”