CHILDREN AND TEEN CARE

What Causes Bedwetting (Nocturnal Enuresis)?

By Richard Asa and Temma Ehrenfeld @temmaehrenfeld
 | 
January 05, 2024
What Causes Bedwetting (Nocturnal Enuresis)?

Children wetting their bed at night is normal and usually has no specific cause. Most will outgrow it. Here's what you can do to stop bedwetting in your child.

Most children can control their bladder during the day and night by the age of 5. But about 10 percent of 6-year-olds and 5 percent of 10-year-olds pass urine while they sleep. Bedwetting is slightly more common among boys and children with behavioral or psychiatric disorders, urologists report.

 

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What is nocturnal enuresis?

Technically known as nocturnal enuresis, bedwetting in most children has no specific cause. The volume of urine is more than their bladders can hold but isn’t enough to wake them up. 

The bladder might signal the brain that it's close to full, but the brain fails to respond with a message to relax and hold the urine until morning. The brain might miss the signals entirely during deep sleep. It’s rare that any serious medical condition is involved.

A child who has never been dry at night has what’s called primary nocturnal enuresis. A child who has had a good period of dry nights, but then develops bedwetting, has secondary nocturnal enuresis. That can happen when children experience stress or traumatic events or when they get sick or constipated.

It’s not your child’s fault. Bedwetting shouldn’t be punished, doctors say.

What causes bedwetting (nocturnal enuresis)?

Possible causes can include:

  • Genetics
  • Difficulty waking up
  • Stress or trauma
  • Slower than normal development of the central nervous system
  • Hormonal factors
  • Urinary tract infections
  • Structural abnormalities
  • A small bladder 

Signs of a medical problem

A child who has been completely toilet trained for six months or longer and suddenly begins wetting the bed may need attention from a pediatrician or pediatric urologist. Look for other symptoms, which might include:

  • Changes in how much and how often your child urinates during the day
  • Pain, burning, or straining while urinating
  • A very small or narrow stream of urine or dribbling
  • Cloudy or pink urine​ or bloodstains on underpants
  • Daytime and nighttime wetting
  • Sudden change in personality or mood
  • Poor bowel control
  • Urinating after stress (such as coughing, running, or lifting)
  • Certain gait disturbances (problems with walking that may mean an underlying neurologic problem)
  • Continuous dampness

Children with attention deficit hyperactivity disorder (ADHD) may be at higher risk, but the problem still isn’t common. In a study of records for 13,000 children ages 6 to 12, more than 3 percent of the kids diagnosed with ADHD had a bed-wetting issue, compared to about 2 percent of non-ADHD children. They were also twice as likely to feel urgency to urinate during the day.

How to stop bedwetting

Wait. Children will gain bladder control at different ages. Most children outgrow bedwetting without treatment. 

If you’re concerned, talk to your child’s pediatrician about your options, which include behavioral therapy and medicine. Behavioral treatments include:

  • Limiting fluids before bedtime
  • Having your child go to the bathroom at the beginning of the bedtime routine and right before sleep
  • Using an alarm system that rings when the bed gets slightly wet, so your child can go to the bathroom before the bed is very wet

You might ask your child to change the sheets when they get wet. Another option is bladder training, in which your child practices holding urine for longer and longer periods during the day. 

Your child’s doctor won’t prescribe medication to children under age 7. One type of medicine lets the bladder hold more urine, and the other reduces the urine the kidneys produce. The medicines could have side effects, such as dry mouth.

It's essential to be supportive. Don’t get discouraged if one type of treatment doesn’t work. Some children will respond to a combination of treatments involving medicines and bedwetting alarms.

How to handle bedwetting with your child

Children who chronically wet the bed can become embarrassed and upset about their condition.

It’s very important that you practice acceptance. Never blame your child. Be honest and direct about what’s happening.

“If you don't make a big issue out of bedwetting, chances are your child won't either. Also remind your child that other children wet the bed,” writes the American Academy of Pediatrics. “Do not let family members, especially siblings, tease your child. Let them know that it's not your child's fault.” 

In most cases, bedwetting decreases as your child's body matures. By the teen years, almost all children outgrow bedwetting. Only about 2 to 3 percent continue to have problems with bedwetting as adults.

 

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Updated:  

January 05, 2024

Reviewed By:  

Janet O’Dell, RN