Bed-wetting (also known as enuresis) is the involuntary release of urine past an age when control is usually expected.
Bobby woke up and felt that, once again, his pajamas and sheets were wet and smelled of urine * . Wetting the bed is why he had turned down Ramon's invitation to a sleepover birthday party planned for the following weekend. At 10 years old, Bobby was ashamed that he still wet the bed. It was not as if he did it on purpose. It just happened. He knew most children his age did not urinate in their sleep, and he was tremendously afraid that his friends would make fun of him if they found out that he did. Better, he thought, to miss the party than to have everyone learn about his problem.
Bed-wetting is also called nocturnal enuresis (nok-TER-nal en-yu-REE-sis). Enuresis is the involuntary, unwanted release of urine either in the day or at night in people who are developmentally old enough (around five to six years old) to have gained bladder * control. Bed-wetting is a specific kind of enuresis that occurs at night during sleep.
Most children are toilet trained by age three, although some continue to use diapers or training pants while sleeping. Children between three and seven years old may wet their beds occasionally, especially if they are sick or particularly tired. About 30 percent of four-year-olds wet the bed. This rate drops to about 10 percent of six- and seven-year-olds, while only about 1 percent of adolescents and adults have problems with bed-wetting. In young children, more boys than girls wet the bed. Some men and women develop incontinence * as they age, often because of medical conditions or medications they take. Bed-wetting becomes a problem when it happens repeatedly in older children. In older children, bed-wetting limits social activities and can be stressful and humiliating. It can contribute to psychological and emotional problems such as low self-esteem * and depression * .
Doctors are not sure why some people experience problems with bladder control and others do not. They do know that bed-wetting tends to run in families. Children who have a parent who wet the bed as a child are between 40 percent and 75 percent more likely to wet the bed themselves, depending on whether one or both their parents had problems with bed-wetting. As of mid-2016, however, no specific genetic cause for bed-wetting had been found.
Some children who wet the bed may sleep so deeply that they are not awakened by the urge to urinate. Other children have bladders that develop more slowly than most. Bed-wetting is sometimes related to medical problems such as infections of the urinary tract, sickle cell anemia * , diabetes * , or epilepsy * . However, most people who wet the bed do not have medical problems.
Bed-wetting also is a common reaction to stress, especially if a person has previously stayed dry at night. For example, some younger children who are toilet trained resume wetting their beds after a new baby is born or parents separate. Starting a new school or moving to a new town can also trigger the condition or make it worse. Still, most bed-wetting does not have an easily identifiable cause.
Research suggests that some people who wet the bed may produce less antidiuretic hormone (an-ti-di-u-RET-ik HOR-mone), or ADH. ADH regulates how concentrated the urine is. People generally produce more ADH at night, allowing them to produce a smaller volume of more concentrated urine while they sleep. People who produce less ADH at night produce a greater volume of urine that is less concentrated (more diluted).
Most children stop bed-wetting without any treatment. Bed-wetting in older children can be treated in different ways depending on what is causing it. First, a doctor does a complete physical examination to determine if bed-wetting is caused by a medical condition. If it is, the underlying condition can be treated medically with drugs or corrective surgery. However, a very small number of adolescents who experience bed-wetting have an underlying medical condition that is responsible for the problem.
If the bed-wetting appears to be caused by emotional or psychological stress or depression, then consultation with a mental health professional is the first step to resolving the problem. Counseling to help deal with the source of stress, combined with behavior modification techniques to bring about nighttime bladder control, is often very effective.
Most people wet the bed for no identified reason. These people are usually helped by behavioral strategies aimed at staying dry during the night. Behavioral modifications such as holding urine for a short time when there is an urge to urinate, rewards for dry nights, and relaxation techniques aimed at reducing stress sometimes help. So do limiting drinking liquids after dinner and avoiding caffeinated beverages, such as colas. Sometimes parents wake their children after a few hours of sleep to encourage them to go to the bathroom and empty their bladder. The most effective behavioral technique (for children over five years old) is the urine alarm. This pad with a bell or alarm attached to it is placed on the bed and individuals sleep on top of the pad. With this technique, an alarm rings at the first sign of wetness in their pajamas or on the sheets. The alarm awakens sleepers and allows them to get up and finish emptying their bladder. In time, their brain comes to recognize the sensation of a full bladder and wakes them before urination occurs and the alarm goes off.
Nighttime dryness sometimes can be achieved by the use of medication. Some medications work to increase urine concentration. Others seem to work by making it easier for a person to wake up when the bladder is full. Some medications are quite effective and work almost immediately, whereas others may become effective over time. However, many people return to wetting the bed as soon as they stop taking the medication. As with all medicines, sometimes side effects occur.
Although bed-wetting is not medically serious, it can have strong negative psychological effects on young people. It restricts their social lives and is embarrassing, upsetting, and frustrating. Fortunately, most people can be helped to stay dry at night through a combination of the strategies that have been mentioned. It is important for parents to offer encouragement to children and help them understand that bed-wetting is a common medical condition, not a personal weakness. Children should also be helped to realize they are not alone in their bed-wetting. They probably know other people who secretly share their problem, but bed-wetting is not something many children discuss with their friends or classmates.
See also Diabetes • Epilepsy • Sickle Cell Anemia • Urinary Tract Infections
Bennett, Howard J. Waking Up Dry: A Guide to Help Children Overcome Bedwetting. 2nd ed. Washington, DC: American Academy of Pediatrics, 2015.
Mercer, Renee. Seven Steps to Nighttime Dryness: A Practical Guide for Parents of Children with Bedwetting. 2nd ed. Ashton, MD: Brooke-ville Media, 2011.
National Sleep Foundation. “Bedwetting.” SleepFoundation.org . http://sleepfoundation.org/sleep-disorders-problems/bedwetting-and-sleep (accessed November 20, 2015).
American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Ave. NW, Washington, DC 20016-3007. Telephone: 202-966-7300. Website: https://www.aacap.org (accessed November 20, 2015).
National Institute of Diabetes and Digestive and Kidney Diseases. 9000 Rockville Pike, Bethesda, MD 20892. Telephone: 301-4963583. Website: http://www.niddk.nih.gov/ (accessed November 22, 2015).
* urine is the liquid waste material secreted by the kidneys and removed from the body through the urinary tract.
* bladder (BLA-der) is the sac that stores urine produced by the kidneys prior to discharge from the body.
* incontinence (in-KON-ti-nens) is the loss of control of urination or bowel movement.
* self-esteem is the value that people put on the mental image that they have of themselves.
* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
* sickle cell anemia, also called sickle cell disease, is a hereditary condition in which the red blood cells, which are usually round, take on an abnormal crescent shape and have a decreased ability to carry oxygen throughout the body.
* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood. This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.
* epilepsy (EP-i-lep-see) is a condition of the nervous system characterized by recurrent seizures that temporarily affect a person's awareness, movements, or sensations. Seizures occur when powerful, rapid bursts of electrical energy interrupt the normal electrical patterns of the brain.