Bedwetting

Written by Zulekha Nishad

Last Updated June 13, 2024

kaneesha allen Fact checked by Kaneesha Allen

Bedwetting affects both children and adults and can be a source of distress for those struggling with the issue. While there are treatments available to reduce or even eliminate bedwetting, knowing what causes it is often a crucial first step in finding the right solution. In this blog post, we'll cover all you need to know about bedwetting, including the different types, potential causes, various treatment options, and more.

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Key Takeaways:

  • Bedwetting refers to involuntary urination during sleep and can occur in both children and adults, but is more common in younger kids.
  • Primary nocturnal enuresis and secondary nocturnal enuresis are the two types of bedwetting.
  • Bedwetting can be caused by various factors, including genetics, urinary tract infection, urinary tract blockage or narrow urethra, anatomical abnormalities, constipation, hormonal imbalance, diabetes, neurological issues, small functional bladder capacity, psychological or emotional problems, and ADHD.
  • Treatment options include behavioral interventions as well as various medications.
  • It's important for individuals who experience this condition to seek medical advice to determine the underlying cause and develop an appropriate treatment plan.

what is bedwetting

What is bedwetting?

Bedwetting, also known as nocturnal enuresis, refers to involuntary urination during sleep. It can occur in both children and adults, but is more common in younger kids. If someone over the age of 7 experiences this condition at least twice a week for more than three months in a row, it becomes a concern.

Approximately 20% of children experience bedwetting issues at the age of 5, and up to 10% continue to do so by the age of 7. As their bladders mature, most children outgrow this condition. However, research indicates that 1 to 2 percent of adults also experience bedwetting, although the actual number may be higher.

Types of bedwetting

There are 2 types of bedwetting: primary nocturnal enuresis and secondary nocturnal enuresis.

Primary nocturnal enuresis

This is the most common type of bedwetting, and it refers to the condition that has been occurring since early childhood without any significant periods of dryness.

Children with primary nocturnal enuresis have never achieved a consistent pattern of dryness at night, and they may have a family history of bedwetting.

Secondary nocturnal enuresis

This type of bedwetting occurs in individuals who have had a period of at least six months of dryness at night but then begin to wet the bed again. Secondary nocturnal enuresis can be a result of medical or psychological conditions.

Causes of bedwetting

Understanding the potential causes of bedwetting can help individuals and their caregivers develop effective strategies for managing this condition.

what causes bedwetting

While bedwetting can be attributed to a lack of bladder control in children, many children gain this control between ages 2 and 4. Nevertheless, it's common for there to be occasional accidents between the ages of 4 and 6 while they're still getting used to their changing bodies. As your child approaches age 7, most have gained control over their bladder; however, if the problem persists beyond this age, it might be the result of an underlying condition.

Have a look at some of the common causes of bedwetting:

Genetics

Bedwetting can run in families, suggesting that genes may play a role in the condition. A study published in the Journal of Urology found that the risk of adult bedwetting was higher among individuals who had a family history of the condition.

Urinary tract infection

UTIs are related to secondary nocturnal enuresis. This condition can cause irritation and inflammation in the bladder, which can make a child feel the urge to urinate more frequently and, sometimes, without warning. However, a urinary tract infection is not something to worry about and can be treated with the right course of medicine.

Anatomical abnormalities

Physical abnormalities of the urinary tract or nervous system can cause bedwetting, especially if the individual has never been dry at night. Some of these include an abnormally small bladder, a deep bladder neck, or a nervous system that does not respond quickly to signals from the bladder when it's complete.

Constipation

When a person is constipated, their rectum can become filled with a solid, dry stool that is hard to pass. This can cause an increase in abdominal pressure, which can put pressure on the bladder and reduce its capacity to hold urine.

Hormonal imbalance

Hormones play an important role in regulating the body's water balance and controlling the production of urine. Antidiuretic hormone (ADH) is one of the hormones released by the pituitary gland, which is responsible for regulating the amount of water reabsorbed by the kidneys. When there's an imbalance, the kidneys won't absorb water, and the urine volume suddenly increases. Then it leads to bedwetting, as the sphincter muscles cannot control the sudden increase in urine production.

In some cases, hormonal changes during menopause can cause the bladder muscles to weaken, leading to incontinence.

Diabetes

In children with type 1 diabetes, bedwetting can occur due to the increased urine production that can result from high blood sugar levels. This is because when blood sugar levels are high, the kidneys may work harder to remove excess glucose from the blood, leading to increased urine production.

In adults with diabetes, bedwetting is less common but can occur as a result of nerve damage that can happen over time in people with poorly controlled diabetes. This condition, called diabetic neuropathy, can affect the nerves that control the bladder.

Neurological issues

Nerve damage, spina bifida, Parkinson's disease, or other neurological conditions can cause an individual to have difficulty controlling their bladder, leading to bedwetting.

Small functional bladder capacity

Some individuals may have a smaller-than-average functional bladder capacity, which means that they need to empty their bladder more frequently than others. This can result in nighttime accidents if they are unable to wake up to use the bathroom.

Psychological or emotional problems

Anxiety, stress, and other psychological or emotional issues can also lead to bedwetting. This is because these conditions can cause an overactive bladder, which can lead to involuntary urine release during sleep.

ADHD

Those with attention deficit/hyperactivity disorder may have difficulty recognizing the signals that their bladder is full, leading to bedwetting.

Obstructive sleep apnea

Individuals with OSA may experience bedwetting due to the sleep disruption caused by their breathing difficulties.

Medication side effects

Certain medications impact the urinary tract and the nervous system. Hence, it could disrupt the communication between the bladder and the brain, causing the bladder muscles to spasm and making it harder to control the urge to urinate. In addition, some medications contain heavy sedation, which doesn't allow the bladder to empty completely. This makes it difficult for the child to not wet the bed during the night.

For example, sedative medications such as benzodiazepines can reduce the body's ability to sense a full bladder, causing the person to urinate unconsciously.

Here are some commonly prescribed benzodiazepines you should be aware of before giving them to your kids - Valium®, Xanax®, Halcion®, Ativan®, and Klonopin® (*Disclaimer: consult your child's doctor as they'll adjust the dosage of your medicines prescribed to you).

How does bedwetting affect your sleep?

how does bedwetting affect your sleep

Bedwetting can have a significant impact on the quality of one's sleep. When an individual wets the bed, they are usually awakened by the feeling of wetness or discomfort, which can lead to sleep disruption. This disruption can cause difficulties falling back asleep, leading to reduced total sleep time and poor sleep quality.

Furthermore, this condition can also lead to psychological distress, such as feelings of shame, embarrassment, and anxiety, which can further disrupt sleep.

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How is nocturnal enuresis diagnosed?

Bedwetting is diagnosed based on a person's medical history, physical examination, and, in some cases, additional tests.

The medical history will involve questions about the frequency, duration, and severity of nighttime and daytime wetting. The medical examiner will also ask about any other symptoms or health conditions that may be contributing to enuresis, such as a urinary tract infection, diabetes, or sleep disorders.

The physical examination will involve checking the abdomen and genitals for any abnormalities. The doctor may also check for signs of constipation, which can contribute to bedwetting.

Additional tests may include a urinalysis to check for a urinary tract infection. In some cases, a bladder function test may be done to evaluate the ability of the bladder to store and empty urine properly. Imaging studies such as renal bladder ultrasound or x-ray may also be performed.

How can you treat bedwetting?

A combination of behavioral changes and medications can be used in order to gain nighttime bladder control.

Behavioral changes

  • Limiting fluids before bedtime:

Encouraging your child to drink more fluids earlier in the day and to reduce fluids before bedtime can help reduce the amount of urine produced during the night.

  • Setting bedwetting alarms

Bedwetting alarms are devices that can be worn to bed and set to sound an alarm when they detect urine. These alarms can help train the child to wake up and use the bathroom when they feel the urge to urinate.

  • Bladder therapy

A variety of bladder training techniques can be used to help manage bedwetting. These include timed voiding, which involves scheduling bathroom breaks at regular intervals, and bladder stretching exercises, which help increase the bladder's capacity.

  • Pelvic floor exercises

Exercises can help strengthen the muscles that control urination. They can be done by having your child squeeze and release the muscles in their pelvic area for a few seconds at a time, several times a day.

pelvic floor exercises to treat bedwetting

Medications

While bedwetting can often be managed with lifestyle changes or behavior modification techniques, medication can be prescribed in some cases.

Even though the above medications are effective against bedwetting, they may have potential side effects. Therefore, we highly recommend that you consult a healthcare provider or your child's pediatrician prior to taking these medicines.

Coping with bedwetting - Tips for parents and caregivers

For parents and caregivers managing a child's bedwetting issue, it's important to remain positive when discussing the condition with them.

  • Create a safe space for open communication without shame or embarrassment about the topic at hand.
  • Avoid punishments that would further add to their insecurity about their condition (such as withholding allowance).
  • Ensure that management techniques are realistic and comfortable for both parties involved so that progress is made without too much stress being put on either side during the process.

coping with bedwetting

When should you seek medical help for bedwetting?

If your child wakes up with wet sheets even after the age of five or six, or if they start wetting the bed again after a period of dry nights, it is important to seek medical advice promptly. These symptoms may indicate an underlying medical condition that requires special attention.

Similarly, if you are experiencing adult-onset primary nocturnal enuresis, it is crucial to seek professional guidance immediately, as this could be a sign of a more serious condition than just nighttime bathroom accidents, such as bladder cancer.

Conclusion

Bedwetting is a common problem that affects both children and adults alike, but luckily there are now effective treatments available that can help individuals manage the condition more effectively (such as behavioral changes, medications like desmopressin, etc.).

Parents/caregivers play an important role in ensuring proper treatment processes take place whilst taking into consideration how difficult it must be for someone dealing with such a sensitive issue. With the right approach, those struggling with this condition can develop healthy bladder habits, leading to improved confidence and quality of life.

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FAQs

When do most children outgrow bedwetting?

Most children who experience primary nocturnal enuresis will eventually outgrow it by age six, but there are some cases where this process takes longer than usual depending on certain factors, e.g., small functional bladder capacity, etc.

Can bedwetting be cured?

Yes – although there isn't one definitive cure for all cases of bed wetting, many types can be successfully settled using various treatments such as lifestyle changes, medications, pelvic floor exercises, etc.

Is bedwetting a sign of a serious medical condition?

It's not always indicative of a serious medical problem, but secondary nocturnal enuresis caused by conditions such as diabetes, urinary tract blockages, etc. should always be taken seriously.

What are bedwetting alarms?

Bedwetting alarms are devices that are designed to help children and adults overcome bedwetting. They work by detecting moisture or wetness in the bed and then sounding an alarm to wake the person up. The idea behind this is that the alarm will help the person associate the feeling of a full bladder with waking up and going to the bathroom, ultimately leading to the development of a new habit of waking up to use the toilet.

How long does bedwetting last?

In most cases, bedwetting is a developmental issue that will resolve on its own over time. However, for some individuals, bedwetting may persist into adulthood. If this condition is causing significant distress or interference with daily activities, it is important to consult with a healthcare professional to determine the underlying cause and appropriate treatment options.

Is bedwetting a psychological condition?

Bedwetting can be a result of either psychological or medical conditions.

Psychological factors contributing to nocturnal enuresis include stress, anxiety, fear, and behavioral problems.

Sometimes, bedwetting may be a symptom of a psychiatric issue such as ADHD or bipolar disorder.

Is it normal for a 10-year-old to wet the bed?

Bedwetting is something that many 10-year-olds experience, and it's nothing to be ashamed of. In fact, around 5-7% of children this age go through it. Although it's more common in younger kids, it can still happen well into the teenage years and even adulthood.

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Disclaimer: What is said in this article has been referenced from multiple sources and is intended only for educational and informational purposes. Please note that no content in this article is a substitute for professional advice from a qualified doctor or healthcare provider. Always consult an experienced doctor with any concerns you may have regarding a health condition or treatment, and never disregard any medical suggestions or delay in seeking treatment because of something you read here.

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