Bedwetting

What is bedwetting (nocturnal enuresis)?

Bedwetting, or nocturnal enuresis, is the accidental or involuntary release of pee while sleeping. Bedwetting is common among children, even after toilet training.

Most children gradually stop wetting the bed on their own as they grow older. This usually happens between 4 and 6 years of age. A healthcare provider will see bedwetting as an issue if your child is over age 12 and continues to wet the bed two or more times a week for at least three months in a row.

Although bedwetting isn’t a serious condition, it can cause stress for your child and family. Children who wet the bed may feel ashamed or embarrassed. They might avoid taking part in activities, such as sleepovers, because they’re worried that they might wet the bed while they’re away from home.

It’s important to understand that bedwetting isn’t the result of poor toilet training or laziness. Many factors lead to nocturnal enuresis among both children and adults.

What are the types of nocturnal enuresis?

There are two main types of bedwetting:

• Primary nocturnal enuresis occurs when a person has never remained dry throughout the night for six months in a row or longer.
• Secondary nocturnal enuresis occurs when a person wets the bed again after not wetting the bed for six months or more. Secondary enuresis is usually the result of a medical or psychological condition.

Who does bedwetting (nocturnal enuresis) affect?

Bedwetting affects people of all ages, from children to adults. Children are still learning to control their bladder, so the condition is more common before age 6. Adults with nocturnal enuresis usually have an underlying medical or psychological condition that leads to bedwetting. Bedwetting occurs more often among boys or children assigned male at birth (AMAB). You may be more at risk of nocturnal enuresis if you have severe emotional trauma or stress. Bedwetting can also be genetic and runs in families if a parent or sibling also had or has this issue.

How common is bedwetting?

About 1 in 10 children in the United States have nocturnal enuresis. It happens more often among younger children — about 30% of children ages 7 and under and about 5% of 10-year-old children. For teenagers, an estimated 1% to 2% of U.S. 15-year-olds have nocturnal enuresis. About 2% to 3% of adults over 18 have primary nocturnal enuresis.

How does bedwetting affect a person’s mental health?

It’s normal for both children and adults to feel embarrassed about bedwetting. It may even be difficult to bring it up to your healthcare provider because you don’t want to feel shame. While your feelings are valid, bedwetting is common. The negative stigma around bedwetting usually causes these feelings. If bedwetting happens to you as an older child, teenager or adult, it’s usually involuntary or a sign that your body isn’t working as you expect it to. A healthcare provider can help you navigate these changes to your body to help you feel better and wake up dry.

What are the symptoms of nocturnal enuresis?

Waking up with wet pajamas or sheets from pee is the main symptom of bedwetting. You likely won’t know that you wet the bed until it’s too late.

While it’s a physical condition, bedwetting can take an extreme emotional toll on anyone who experiences it. You may feel embarrassed or ashamed. You may try to hide your wet clothes or sheets from others so they don’t see. You may also avoid social interactions at night like sleepovers to avoid accidents that can happen around others. These distressing symptoms go away after bedwetting resolves, but they can seriously affect you when they happen.

Is bedwetting a symptom of an underlying medical condition?

Bedwetting can be a symptom of an underlying medical condition if it occurs in a toilet-trained person who has frequent bedwetting episodes after not having any for at least six months. Some signs that there may be an underlying medical issue causing bedwetting include:

• Changes to the frequency of when and how much you pee during the daytime.
• Pain while peeing.
• Having a small stream of pee.
• Color changes to your pee.
• Changes to your mood.
• Lack of bowel movements during the day.

What causes bedwetting (nocturnal enuresis)?

The cause of bedwetting can vary by age. There are several possible causes as to why people wet the bed.

Causes of childhood bedwetting

The most common cause of childhood bedwetting is a lack of bladder control. Children usually learn to control their bladder between ages 2 to 4. It’s common for children to wet the bed between the ages of 4 to 6 as they grow and adapt to their bodies at their own pace. The majority of children gain control of their bladders by age 7. After age 7 and throughout your child’s teenage years, accidents can happen.

In some cases, frequent or recurring bedwetting may be a sign of an underlying medical condition, like:

• A urinary tract infection.
• Constipation.
• Spina bifida or nerve problems.
• Diabetes.
• A urinary tract blockage or narrow urethra.
• Obstructive sleep apnea.
• ADHD.

Causes of adult bedwetting

People over the age of 18 can have nocturnal enuresis. Potential causes for adult bedwetting could include:

• Genetics: Some people have a genetic predisposition to bedwetting. This means that if a person’s biological parents had nocturnal enuresis, their children are more likely to have the same condition.
• Constipation: Pressure from extra poop inside your rectum may interfere with the nerve signals that your bladder sends to your brain. A full rectum can also reduce the amount of pee that your bladder can hold or prevent it from emptying completely.
• Hormones: A hormone called vasopressin limits the volume of pee that your body produces during the night. Vasopressin works by causing water in pee to be reabsorbed by your bloodstream. This causes a smaller volume of pee to enter your bladder. People who don’t produce enough vasopressin may be more likely to wet the bed.
• Small functional bladder capacity: People with a small functional bladder capacity have normal-sized bladders, but they sense that their bladders are full even when the bladder can still hold more pee. They tend to pee more often during the day and they might have a sudden urge to run to the bathroom to prevent an accident. This also makes them more likely to wet the bed during the night.
• Failure to awaken during the night: Sometimes people are unable to wake up in time to get to the bathroom. As your bladder fills with urine, it sends a signal to your brain. Your brain sends a signal back to your bladder to relax so it can hold more pee. A full bladder continues to send signals to your brain so that you’ll wake up. Sometimes, an underlying condition can interrupt these signals, which prevents you from getting up in the middle of the night.
• Psychological or emotional problems: Emotional stress caused by traumatic events or disruptions in your normal routine can cause bedwetting. For example, moving to a new home, enrolling in a new school, the death of a loved one or sexual abuse may cause bedwetting episodes. These can become less frequent over time and improve after speaking with a mental health professional.
• Medical conditions: An underlying medical condition may be the cause of adult bedwetting, like sickle cell disease, neurological changes and kidney or bladder abnormalities. If bedwetting recurs after you’ve had dry nights for six months or more, a medical condition may be causing it.

A healthcare provider can help you navigate what caused nocturnal enuresis and offer treatment to help you feel better each morning.

How is nocturnal enuresis diagnosed?

A healthcare provider will diagnose nocturnal enuresis after a physical exam and taking a complete medical history. Your provider may offer tests, like a urine test, a blood test or an imaging test, to determine if an underlying medical condition caused bedwetting. If your provider suspects that emotional or psychological factors caused nocturnal enuresis, they may recommend you speak with a mental health professional.

Do I need to see a healthcare provider about bedwetting?

Bedwetting is very normal and common. It’s a good idea to talk to your provider about it if it happens at night. However, daytime wetting (enuresis) isn’t typically normal. Your child may have daytime wetting if they’re too busy playing and they don’t want to go to the bathroom. Since daytime wetting isn’t as common, it should always be evaluated.

How is bedwetting (nocturnal enuresis) treated?

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

• Behavioral changes before or during bedtime like using an alarm.
• Managing or treating any underlying medical conditions.
• Taking medications that can reduce nighttime pee production.
• Talking with a mental health professional, psychologist or therapist to manage your stress, trauma or emotional challenges.

Adults with nocturnal enuresis who tried all other noninvasive forms of treatment without success may be candidates for surgery. Surgery can stimulate your bladder, bowels and pelvic floor (sacral nerve) or remove muscle that surrounds your bladder to improve bladder contractions.

Behavioral changes

Your healthcare provider may suggest trying behavioral changes to stop bedwetting. Behavioral techniques are things you can do to your or your child’s nighttime routine that don’t involve medication. These techniques can include:

• Limiting fluids before bedtime: Don’t give your child anything to drink at least two hours before bedtime. Make sure your child drinks plenty of fluids during the day. While this may reduce their fluid intake, it doesn’t always prevent bedwetting, but it can lessen the amount that they pee at night.
• Going to the bathroom before bedtime: Make sure your child goes to the bathroom and empties their bladder before going to bed. Even if your child doesn’t have the urge or desire to pee, have them try to pee or sit on the toilet for a few minutes before sleep to try to empty out their bladder.
• Setting an alarm: An enuresis alarm is a device that makes a loud noise or vibrates to awaken you or your child when it detects wetness. It has a sensor that triggers the alarm so that you can wake up and finish urinating in the bathroom. Over time, you’ll learn to wake up when you feel the sensation of a full bladder, and eventually might be able to sleep through the night without having to pee. This technique may take several months to be successful.
• Bladder therapy: This approach gradually increases your bladder’s functional capacity by making you wait to go to the bathroom during the daytime. Increasing the length of time between bathroom visits helps enlarge your bladder to allow it to hold more pee.

Medications

The following medications may be used alone or in combination with behavioral techniques to treat bedwetting:

• Desmopressin:This is the man-made version of the hormone vasopressin, which causes the kidneys to produce less pee. It’s effective in about half of all cases, with better results in older children who have normal bladder capacity. The medication can lower sodium levels in children who take it, so you should limit the amount of fluids your child drinks after dinner.
• Oxybutynin or tolterodine:This medication treats an overactive bladder by reducing bladder contractions. You can take this with desmopressin or the enuresis alarm method. It may be effective for children who wet the bed more than once each night and who also have daytime wetting.
• Imipramine:This medication prevents bedwetting in an estimated 40% of cases by increasing brain signals to different parts of your body, like your bladder. Your provider will let you know of any drug interactions or side effects associated with this medication that may be harmful.
• Solifenacin: An anticholinergic medication that controls nerve impulses to prevent an overactive bladder. This medication has fewer side effects than traditional anticholinergic medications.
• Trospium chloride: A medication that helps your bladder relax by blocking muscle cell receptors on your bladder wall. It prevents bladder over-activity.

How can I prevent bedwetting?

Bedwetting is normal and common. Accidents are also normal. While you can’t prevent all cases of bedwetting, you can reduce your risk by:

• Not drinking a lot of fluids two hours before bedtime and avoiding caffeinated beverages.
• Going to the bathroom before bed.
• Wearing absorbent pants at night.
• Making sure the bathroom or toilet is easily accessible.
• Using positive reinforcement or affirmations to acknowledge when your child wakes up dry.
• Avoid shaming or making fun of someone in your family or friend group who has nocturnal enuresis.

How long does bedwetting last?

Bedwetting is common and doesn’t typically last forever. Children usually grow out of the condition when they learn to control their bladder. If an underlying condition caused bedwetting, treating that condition will stop or reduce bedwetting. It may take time to manage nocturnal enuresis, but it’s a treatable condition.

It can be a very stressful issue for anyone who has nocturnal enuresis, as well as for parents and caregivers. Some people find comfort in speaking to a mental health professional. It’s important to remember that your healthcare team is there to provide support and help you through this. Reach out to discuss any questions you might have.

When should I see my healthcare provider?

Visit a healthcare provider if:

• You have questions about the frequency of bedwetting.
• Bedwetting happens with daytime wetting.
• Sudden accidents happen after having no accidents for several months.
• Accidents happen after age 12.

What questions should I ask my doctor?

• What caused my (or my child’s) nocturnal enuresis?
• What changes to my (or my child’s) behavior will prevent bedwetting?
• Are there side effects to the medications you prescribe?
• How do I make my child feel better if they’re embarrassed?

A note from Cleveland Clinic

Bedwetting is a very emotional and often challenging condition to manage. You or your child may feel embarrassed or stressed about not being able to control your bladder at night. Positive encouragement and making small behavioral changes before bedtime can help people with nocturnal enuresis. Your healthcare provider can offer treatment options if behavioral changes aren’t successful so you can wake up dry and at ease.