Bedwetting
Also known as: Nocturnal enuresis, Night-time wetting
Bedwetting, known medically as nocturnal enuresis, is the involuntary passing of urine during sleep in a child old enough to be expected to stay dry, usually taken as five years or older. It is very common, affecting a sizeable proportion of five-year-olds and a smaller but still significant number of older children and teenagers. Most bedwetting happens because a child's bladder has not yet developed the capacity, the night-time hormone signals that reduce urine production, or the ability to wake in response to a full bladder. It is not caused by laziness or naughtiness, and punishment makes it worse. Most children stop on their own, and for those who do not, effective treatments such as bedwetting alarms and medication are available.
At a Glance
- Common symptoms
- Wetting the bed during sleep, from occasionally to every night, Deep sleep from which the child is difficult to wake, Embarrassment, low self-esteem, or avoiding sleepovers and school trips
- Main treatments
- Reassurance and watchful waiting for younger children, as many simply grow out of it, Bedwetting alarm: a sensor that sounds when wetting starts, training the child to wake; the most effective long-term treatment, usually used for 8 to 12 weeks, Desmopressin, a medication that reduces urine production overnight, useful for short-term control such as sleepovers or if alarms have not worked
- Category
- Pediatric · Very common; affects a significant proportion of five-year-olds, with numbers falling steadily each year through childhood
- See a doctor if
- Bedwetting continues after age 5 to 7 and is upsetting the child or family
Symptoms
Causes
- Slower maturation of bladder control and the brain's ability to wake to a full bladder
- Producing a large volume of urine at night due to lower night-time levels of antidiuretic hormone
- A small functional bladder capacity or an overactive bladder
- Constipation, where a full bowel presses on the bladder
- Stress or emotional upheaval, such as a new sibling, moving house, or problems at school (more often in secondary enuresis)
- Less commonly, urinary tract infection, diabetes, sleep apnoea, or structural abnormalities of the urinary tract
Risk Factors
- A parent who wet the bed as a child (the strongest predictor)
- Being a boy
- Deep sleeping or disrupted sleep from snoring or sleep apnoea
- Constipation
- ADHD or developmental delay
- Stressful life events
Diagnosis
- A history covering how often wetting occurs, daytime symptoms, fluid intake, bowel habits, and family history
- Physical examination, including the abdomen, back, and genitals
- Urine test to rule out infection or diabetes
- A bladder diary recording drinks, toilet visits, and wet nights for a week or two
- Ultrasound or other tests only if daytime symptoms, infections, or examination findings suggest an underlying problem
Treatment
- Reassurance and watchful waiting for younger children, as many simply grow out of it
- Bedwetting alarm: a sensor that sounds when wetting starts, training the child to wake; the most effective long-term treatment, usually used for 8 to 12 weeks
- Desmopressin, a medication that reduces urine production overnight, useful for short-term control such as sleepovers or if alarms have not worked
- Treating constipation, which alone can resolve wetting in some children
- Reward charts for agreed behaviours such as drinking well in the day and using the toilet before bed, not for dry nights, which the child cannot control
- Anticholinergic medication for children with an overactive bladder, under specialist guidance
- Supportive: regular daytime drinks, avoiding caffeine, using the toilet before bed, waterproof mattress covers, and easy access to the toilet at night
Prevention
- Encourage six to eight drinks spread across the day and avoid large drinks in the hour or two before bed
- Avoid caffeinated and fizzy drinks in the evening
- Establish a routine of using the toilet before bed
- Treat constipation promptly and keep the diet rich in fibre
- Respond calmly to wet nights and never punish or shame the child
When to See a Doctor
- Bedwetting continues after age 5 to 7 and is upsetting the child or family
- Wetting restarts after at least 6 months of dry nights
- Daytime wetting, pain on passing urine, unusually frequent urination, or increased thirst
- Loud snoring or pauses in breathing during sleep
- Constipation, soiling, or any concern about the child's development
Frequently Asked Questions
Related Conditions
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