Bedwetting in Children (Nocturnal Enuresis)

What Causes Bedwetting?

It is normal for children under 6 to not have full control of their bladder, and most will gain better control as they get older. Even children who are fully toilet trained during the day may continue to have accidents at night. Most children outgrow bedwetting on their own or with the help of some simple strategies. In some less common cases, bedwetting may be a sign of an underlying condition.

Enuresis has many possible causes. These can include anatomical problems, hormone issues, medical conditions, and emotional or psychological factors. Some common causes include:

• Anxiety or stress
• Attention deficit/hyperactivity disorder (ADHD)
• Chronic constipation
• Diabetes
• Genetics or family history of bedwetting
• Not enough antidiuretic hormone (ADH) in the body during sleep
• Obstructive sleep apnea (OSA)
• Overactive bladder
• Small bladder
• Structural problems in the urinary tract
• Urinary tract infection (UTI)
• Very deep sleep

Diagnosing Bedwetting

Bedwetting is common in younger children and often resolves on its own as the child gets older. However, if your child is still wetting the bed after the age of 7, or if they start wetting the bed again after a period of dryness, it’s worth a discussion with their healthcare provider. They can help pinpoint any underlying issues or factors contributing to bedwetting and help your family devise strategies for better bladder control at night.

Diagnosing nocturnal enuresis may involve:

• A physical exam.
• Discussion of symptoms, fluid intake, family history, bowel and bladder habits, and problems caused by bed-wetting.
• Urine tests to check for infection, diabetes or other medical conditions.
• Imaging tests of the kidneys or bladder to look for potential structural issues.
• Other types of urinary tract tests or assessments, if needed.

Treating Bedwetting in Children

Treatment for nocturnal enuresis varies based on the cause. Treatment options could include:

• Behavioral changes, such as limiting fluids prior to bedtime and making sure to empty the bladder completely before bed.
• Using a moisture alarm, which alerts your child to nighttime wetness and over time can help train them to detect the sensation of a full bladder while sleeping.
• Medications that can reduce urine production and night and calm an overactive bladder.
• Talking with a mental health professional, psychologist or therapist to manage anxiety, trauma or emotional challenges.
• Managing or treating any underlying medical conditions.

The most important factor in successfully treating bedwetting is that the child is fully committed to working on it, with the support of their parents.