What Causes Bedwetting (Nocturnal Enuresis)?

By Richard Asa @RickAsa
November 22, 2016

Nocturnal enuresis, or bedwetting, tends to decrease as a child’s body grows, but until then they need emotional support.

It’s estimated that seven million children wet their beds regularly, according to The Sleep Foundation. But it’s normal for children to wet the bed, with it becoming a problem only after age seven. 

What is nocturnal enuresis?

Technically known as nocturnal enuresis, bedwetting means children pass urine in the night when they are asleep. Many parents expect children aged 3 to be dry at night. 

A child who has never been dry at night has primary nocturnal enuresis. A child who has had a good period of dry nights, but then develops bedwetting has secondary nocturnal enuresis. Bedwetting is twice as common in boys as it is in girls.  

What causes bedwetting (nocturnal enuresis)?

In most children there’s no specific cause, and it’s not your child’s fault. Your child wets the bed simply ocurs because the volume of urine is more than his bladder can hold but doesn’t seem to be enough to wake him up. 

Possible causes can include genetics (it runs in families), difficulty waking up, stress, slower than normal development of the central nervous system, hormonal factors, urinary tract infections, structural abnormalities, and a small bladder. 

Children will gain bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. 

Most children outgrow bedwetting without treatment. 

If treatment is needed there are two kinds: behavior therapy and medicine. 

How to stop bedwetting

Behavioral treatments include limiting fluids before bedtime, having your children go to the bathroom at the beginning of the bedtime routine and right before sleep, and using an alarm system that rings when the bed gets wet and causes a response in the child. 

Options can also include applying a reward system for dry nights, asking your child to change the sheets when they get wet, and bladder training in which your child practices holding urine for longer and longer periods during the day. 

If your child is age seven or older and is still bedwetting, your doctor may prescribe a medicine, which is not a cure for the condition. One type of medicine lets the bladder hold more urine, and the other reduces the urine the kidneys produce. These medicines could have side effects, such as dry mouth. 

There is some evidence that children who chronically wet the bed have lower self-esteem. But the cause is straightforward – kids are embarrassed and upset by their condition. When they are treated successfully, self-esteem improves. 

There is also evidence that children with ADHD are at higher risk. A large study of 8- to 11-year-old American children found that kids with ADHD were more likely to show symptoms of nocturnal enuresis, according to Parenting Science

How to handle bedwetting with your child

It’s very important that you are not punitive about your child’s bedwetting. Never blame your child and be honest about what’s happening. That keeps the bedwetting from becoming a major psychological barrier for your child and makes it a normal condition.

“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 American Academy of Pediatrics (AAP). “Do not let family members, especially siblings, tease your child. Let them know that it's not your child's fault.” 

Don’t get discouraged if one type of treatment doesn’t work, the AAP writes. Some children will respond to a combination of treatments involving medicines and bedwetting alarms. This could involve care by a pediatric doctor. 

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

“Until your child outgrows bedwetting, your child will need a lot of emotional support from your family. Support from your child's doctor, pediatric urologist, or mental health professional also can help.”


February 27, 2020

Reviewed By:  

Janet O’Dell, RN