Bedwetting (Nocturnal Enuresis): Causes, Symptoms & Treatment

Bedwetting or nocturnal enuresis is involuntary urination while sleeping at an age when staying dry can be reasonably expected. Soggy pajamas, wet sheets and an embarrassed kid are familiar scenes in many homes. But there’s no need to worry as is often a normal part of development.

In this article, we will discuss the causes of bed wetting, its symptoms, complications and treatment.

What are the reasons for bedwetting?

There can be several reasons for bedwetting among both children and adults. As children are still learning bladder control, nocturnal enuresis can be more common before age 6. Additionally, if a child or even an adult is dealing with a stressful condition or trauma, they are at a higher risk for bedwetting.

Sometimes, adults or children may wet their beds because of an underlying medical or psychological condition. Bedwetting can also be caused because of genetics. We will discuss the causes of bed wetting in more detail further.

Symptoms of bedwetting

Bedwetting is most common among children between the ages of 4 to 7. Here are some of the common symptoms of nocturnal enuresis:

• Waking up with wet pajamas and sheets

• Smell of pee from clothes and bedding

• Feeling embarrassed and ashamed

• Trying to hide wet clothes and sheets from others

• Avoiding social interactions like sleepovers

Causes of bedwetting

Although there isn’t a definite cause for bedwetting, certain factors can play a role in this condition such as:

• Small bladder

A child’s bladder may not be developed enough to hold the urine produced at night.

• Inability to identify a full bladder

Sometimes the nerves that control the bladder may take time to mature and if a child is a deep sleeper, they may not wake up to pee even though their bladder is full.

• Hormonal imbalance

Some children may not produce enough amounts of anti-diuretic hormone (ADH), responsible for slowing down nighttime urine production.

• Urinary tract infection

A urinary tract infection can make it hard for a child to control their urination. Signs and symptoms of UTI in kids can include bedwetting, frequent urination, daytime accidents, pain during urination and red or pink urine.

• Sleep apnea

Sometimes nocturnal enuresis can be a sign of obstructive sleep apnea, which affects a child’s breathing during sleep often due to inflamed or enlarged tonsils. Other symptoms may include snoring and daytime drowsiness.

• Diabetes

Bedwetting can also be an early sign of diabetes and is often accompanied by passing large amounts of urine, increased thirst, fatigue and weight loss despite good appetite.

• Structural problem in urinary tract or nervous system

Although rare, bedwetting may also be related to a defect in the child’s neurological system or urinary system.

• Chronic constipation

The same muscles control the elimination of urine and stool. That’s why in case of long-term constipation, these muscles may become dysfunctional and lead to bedwetting.

Risks of bedwetting

Nocturnal enuresis can affect anyone but it is twice as common in boys compared to girls. Several factors can increase a person’s risk of bedwetting, including:

• Stress and anxiety

Stressful events like starting a new school, getting a little sibling or sleeping at someone else’s home can trigger bedwetting.

• ADHD

Children who have attention-deficit/hyperactivity disorder are more likely to experience bedwetting.

• Family history

If one or both parents of a child experienced nocturnal enuresis in their childhood, then their child is also likely to experience bedwetting.

Complications in bedwetting

While bedwetting can be frustrating, without a physical cause it doesn’t pose any health risks. However, nocturnal enuresis can create some complications for a child such as:

• Embarrassment and guilt which may lower their self-esteem

• Loss of social interaction opportunities like sleepover or camp

• Sleeping in wet clothes or sheets may cause rashes on the child’s bottom or genital area

What is the treatment for bedwetting?

Most kids outgrow bedwetting on their own but if your child needs any additional help, here are some options for bed wetting treatment:

• Moisture alarms

Moisture alarms are battery-operated devices that connect to a moisture-sensitive pad on the child’s clothing or bedding. The moisture alarm sounds as soon as the child begins to urinate to help wake them up and get to the washroom. Moisture alarms can take at least 1-4 months to treat bedwetting.

• Lifestyle changes

Lifestyle changes such as limiting fluids in the evening, discouraging caffeine, encouraging double voiding (urinating at the start of the bedtime routine and once again just before sleeping) and promoting the use of the toilet throughout the day can help reduce the bedwetting incidents.

• Alternative medicine

You may also try a non-conventional approach such as acupuncture, hypnosis, chiropractic therapy and herbal therapy along with other treatments to combat bedwetting.

• Medications

Your doctor may recommend some medications to the child as a last resort to stop nocturnal enuresis. Medications like desmopressin can reduce nighttime urine production while drugs such as oxybutynin can help reduce bladder contractions and increase its capacity.

Sometimes a combination of treatments can be the most effective way to treat bedwetting. However, if bedwetting is a symptom of some other underlying condition, it’s best to identify and treat that condition.