Nocturnal Enuresis (Bedwetting)

If you ask any parent, they’d probably tell you their child has wet the bed at a time or two. And while wet bedding is a normal occurrence on the bumpy road to potty training, the majority of children stop nighttime bedwetting between the ages of five and seven. Some children will continue wetting the bed at night for even longer, but if your child is persistently wetting the bed at night past the age of 7, the American Academy of Pediatrics (AAP) does recommend they see a pediatrician to rule out a potential medical issue. While bedwetting can be a normal part of your child’s development, a small percentage of adults also struggle with bedwetting.

What Is Bedwetting or Nocturnal Enuresis?

Dr. Lynelle Schneeberg, PsyD, Licensed clinical psychologist and Director of the Behavioral Sleep Program at Connecticut Children’s Medical Center, says, “Nocturnal enuresis is the medical term for bedwetting. Also known as nighttime incontinence, bedwetting is passing urine at night (while still in bed) at least twice a week for at least three months without meaning to.” (1)

Bedwetting is a normal part of your child’s development and is not usually considered a medical issue unless it extends beyond a certain age. “Most kids are dry at night by about age five,” says Schneeberg. “However, pediatricians and sleep specialists don’t usually treat this as a problem until about age seven.”

“After age six or seven, bedwetting can become a source of embarrassment for a child,” she continues. “Moreover, nocturnal enuresis might also have a “social cost” — having the child miss out on things that other children the same age are doing, like sleepovers or summer camp — ” and the longer it goes on, the more problematic it becomes.

Primary versus Secondary Nocturnal Enuresis

Doctors often classify bedwetting into two types: primary and secondary nocturnal enuresis.

Primary Nocturnal Enuresis

The most common type of bedwetting is primary nocturnal enuresis, where the child has never been consistently dry at night for a period of six months. Developmental, genetic, or hormonal factors may cause primary enuresis — more on these later! (1)

Secondary Nocturnal Enuresis

Secondary nocturnal enuresis is an onset of bedwetting after six months of nocturnal dryness. This type of bedwetting usually has an identifiable cause. While stress is the most common cause of secondary nocturnal enuresis, it can also be a result of changes in your child’s environment (good or bad). (1)

Common triggers of secondary nocturnal enuresis include:

• The arrival of a new sibling
• Parental marriage issues or divorce
• A new home or school
• Social issues (bullying)
• Abuse

Symptoms of Nocturnal Enuresis

It should come as no surprise that the most recognizable symptom of nocturnal enuresis is waking up to wet sheets and bedding. But beyond the physical discomfort, bedwetting can cause:

• Sleep disruption/sleep fragmentation
• Excessive daytime sleepiness

Moreover, bedwetting can also take an emotional toll on your child and your family. Prolonged bedwetting can: (1)

• Impact your child’s (and your family’s) quality of life
• Affect their academic performance
• Cause low self-esteem
• Lead to higher levels of stress for everyone in the home

Children and Bedwetting

It’s estimated that about 15 percent of five-year-olds wet their bed, and that percentage drops to 10 percent for seven-year-olds. (1) The prevalence of bedwetting drops even lower among adolescents (2 percent), and the condition is least prevalent among adults, as only 0.5 to 1 percent of adults are affected by bedwetting. Bedwetting is more common among boys, with research showing it occurs at a ratio of 3 to 1 compared to girls. (1)

Causes of Primary Nocturnal Enuresis in Kids

“The most common cause of bedwetting in kids is deep sleep,” says Schneeberg. And there’s no mystery or complicated science here — the child simply sleeps so deeply that even a full bladder doesn’t wake them. Other causes of nocturnal enuresis include:

• Untreated sleep apnea
• Hormonal imbalance
• Genetic factors
• Diabetes
• Urinary tract infection
• A lack of awareness
• A small bladder

Hormone Imbalance

For most people, the body produces a hormone that decreases urine production by the kidneys. When we sleep, that hormone — the antidiuretic hormone (ADH) — rises, causing our bladders to fill more slowly. (2) For some kids, bedwetting occurs when their body doesn’t produce enough ADH. The nightly rise in ADH and corresponding decrease in urine production doesn’t happen, and the result is a wet bed.

Genetics

If parents wet the bed when they were younger, chances are their child will, too. Research shows one affected parent boosts the child’s chance of bedwetting by 44 percent, and two affected parents bump the probability to a whopping 77 percent. (1)

Urinary Tract Infections

If you always have a jug of cranberry juice in your fridge, you may know that one of the unfortunate hallmarks of a UTI is the frequent urge or need to urinate. If your child has a urinary tract infection, bedwetting is likely just one of the many symptoms. (3)

Sleep Apnea

Believe it or not, bedwetting could be a sign of obstructive sleep apnea (OSA). Sleep apnea is when your child’s breathing is interrupted during sleep. And while sleep apnea in kids is often due to swollen, irritated, or enlarged tonsils or adenoids, bedwetting is a common symptom. In fact, studies have shown that 10–40 percent of children with OSA have enuresis as well. (4) Other symptoms of OSA include loud snoring, pauses in breathing, and excessive daytime sleepiness.

Diabetes

If your child has suddenly started wetting their bed after being dry at night for some time, that may be one of the first signs of diabetes. (5) If you find bedwetting paired with increased thirst, passing large amounts of urine at once, extreme lethargy, and weight loss, it’s worth speaking with your child’s doctor for guidance.

Other Factors

For some kids, bedwetting may simply be the result of a small bladder. For others, the
nerves that control the bladder may be slow to mature. In this case, it’s likely they won’t be awakened by a full bladder, and everyone in the house will have to wait the phase out with as much patience as possible. (2)

Adults and Bedwetting

While its prevalence in adults is lower than in kids, a small portion of the adult population may also find themselves dealing with nocturnal enuresis. Research shows that about 1 percent of adults wet the bed. (1) And while bedwetting is a normal part of development for kids, it can be an indicator of an underlying health condition for adults.

Causes of Adult Nocturnal Enuresis

For the most part, adult bedwetting is caused by the same conditions that cause it in kids. As we outlined earlier, bedwetting may be caused by: (6)

• Sleep apnea
• Urinary Tract Infection (UTI)
• Hormonal issues
• Diabetes
• A small bladder
• An overactive bladder

The differentiators in the causes of bedwetting between adults and kids are conditions that come with advanced age and lifestyle factors.

Enlarged Prostate

A structural problem with the prostate, such as an enlarged prostate, which is common in older males especially, could lead to new onset nighttime bedwetting. An enlarged prostate could be a sign of a more serious condition, like cancer, or occur on its own.

Cancer

A sudden onset of bedwetting in adulthood could be a sign of more serious health issues like bladder cancer or prostate cancer. If nighttime enuresis is accompanied by blood in the urine and frequent urination, experts recommend speaking with your doctor immediately. (6)

Lifestyle Factors

Adults are more likely to experience nocturnal enuresis as a result of lifestyle factors as well.
Common factors associated with adult bedwetting include:

• Alcohol and caffeine consumption both increase urinary production.
• Medications like sedatives, psychiatric drugs (like Clozapine used to treat schizophrenia), and those used to treat insomnia can cause a rapid increase in urine production. (8)
• Sedentary lifestyles have often been linked to sleep disturbances and frequent nighttime urination. (9)
• Stress and anxiety may also contribute to adult bedwetting.
  (10)

How Is Bedwetting Diagnosed?

According to Scheeberg, doctors can diagnose bedwetting in kids based on reports and information from a parent or caregiver. And as you might suspect, adults can relay that information themselves. In the case of both adults and children, the patient may be referred to a urologist to rule out (or confirm) any underlying medical issues. From there, a doctor or behavioral sleep specialist may pick up with the patient for treatment.

How to Prevent Bedwetting

Scheeberg says bedwetting might be prevented by ensuring that the child is getting plenty of sleep and limiting liquids after a certain time of day, although she notes the latter option doesn’t have a high success rate with kids.

Other ways to prevent bedwetting in kids include: (11)

• Avoiding punishment, shame, or blame
• Cheering them on and praising them for dry nights
• Resisting the urge to use plastic pants or diapers (cloth pants or clothing are better reminders to stay dry)
• Waking your child during the night for a trip to the bathroom
• Being patient when accidents happen

A few ways to prevent bedwetting in adults include: (6)

• Medications (be sure to speak with your doctor)
• Getting up during the night to empty your bladder
• Monitoring your fluid intake
• Skipping the nightcap or dessert coffee
• Getting up and getting active
• Finding ways to manage stress and anxiety (i.e., meditation, exercise, therapy, or yoga)
• Bladder and pelvic floor exercises to strengthen bladder muscles

When to Call a Doctor

It may be time to speak with your pediatrician if your child is over the age of five and fully potty trained but still wetting the bed, or if your child has had a period where they remained dry and bedwetting begins out of nowhere (and persists).

Adults dealing with regular or new onset bedwetting may want to consider speaking to their doctor sooner rather than later.

How Is Bedwetting Treated?

While Schneeberg tells us that medication is recommended to treat bedwetting, she notes that
studies indicate that the most successful and lasting treatment is with the use of a moisture-sensing alarm.

Medications

While no pill can “cure” nocturnal enuresis, there are plenty of pharmacological options to help manage the condition and provide some degree of relief. Typically, a doctor will only prescribe medications for adults, though it may depend on the exact cause of the bedwetting. The most common medications for bedwetting include: (6)

• Desmopressin – mimics ADH, so the kidneys produce less urine
• Darifenacin – relieves bladder spasms and treats overactive bladder
• Imipramine – which is thought to work at the brainstem level, promoting arousal and inhibiting urination
• Oxybutynin – relaxes bladder muscles

Moisture Sensors

For children, a non-pharmacological route, such as a moisture sensor, is usually preferred as a first-line treatment. “This alarm has a moisture sensor clipped into the child’s underwear in the spot where the first few drops of urine would likely come in contact with the sensor,” says Schneeberg. “When the child begins to urinate at night, the sensor will detect moisture, and the alarm will sound. The parent is the one who must listen for this alarm — again, because the child is often a very deep sleeper. Ideally, the parent will respond quickly and ask the child to stand up and walk to the bathroom (and would help them to do so).”

Studies show that while moisture sensors require strict adherence and daily use, they have considerably high success rates. In some cases, cure rates are as high as 66 –70 percent. (1)

The Last Word From Sleepopolis

Bedwetting can happen to anyone at any age, and though it may cause embarrassment, there’s often something else at play. While a one-off accident is not a cause for concern, frequent episodes could indicate a larger health issue. Regular or sudden and persistent bedwetting is something worth speaking to your doctor about.

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Sharon Brandwein

Sharon Brandwein is a Certified Sleep Science Coach and a freelance writer. She specializes in health and beauty, parenting, and of course, all things sleep. Sharon’s work has also appeared on ABC News, USAToday, and Forbes. When she’s not busy writing, you might find her somewhere curating a wardrobe for her puppy.