Bedwetting
(Enuresis · Bed Wetting)
In this condition factsheet:
The Facts on Bedwetting
Bedwetting is common for children, affecting more boys than girls. The condition occurs in approximately 15% of children at the age of 5 years, 7% of children at the age of 8, and declines to 1% to 2% of children by the age of 15 years. It continues to affect 0.5% of individuals into adulthood. When a child who is old enough to have bladder control urinates accidentally while sleeping, it's called nocturnal enuresis.
Causes of Bedwetting
There are two main types of nocturnal enuresis: primary and secondary. The primary type is a condition where a child still wets the bed after age 5 or 6. It's often hereditary. The secondary type occurs when a child who had stopped bedwetting for at least six months starts again, often due to emotional stress or a medical condition.
Possible causes of primary nocturnal enuresis include the following:
- delay in maturation of bladder control or incomplete toilet training
- genetics – children with parents who also wet the bed beyond age 5 are at an increased risk for bedwetting
- constipation – this may not allow children to empty their bladder completely
- urination patterns – children who suppress their urge to urinate or postpone urinating may not develop coordination with sphincter control and bladder control
- high nighttime urine volume
Rare possible causes include the following:
- problems with antidiuretic hormone (ADH), a hormone that causes the body to retain water – normally, ADH levels increase at night to decrease the amount of urine produced; however, children with enuresis do not have increased ADH levels at night, causing greater urine production, which can lead to bedwetting
- minor nerve damage – this may decrease a child's ability to sense a full bladder
Although it is often said that emotional stress causes primary nocturnal enuresis, there is little scientific evidence to support this claim. However, bedwetting itself may lead to feelings of shame and lowered self-esteem.
Causes of secondary nocturnal enuresis include the following:
- emotional stress (e.g., birth of a sibling, significant loss, family discord)
- urinary tract infection
- diabetes mellitus (rarely)
Symptoms and Complications of Bedwetting
For sleeping children who are old enough to control their bladders, the symptoms of bedwetting are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them.
The most common complication of bedwetting is the impact on self-esteem and the emotional distress it causes children. Assuring children that the occurrences are accidental (and not blaming the condition on them) is key to managing the psychological effects. Many children who wet the bed may fear staying overnight at a friend's house in case they wet the bed there.
