Bed-wetting

Overview

Bed-wetting ― also called nighttime incontinence or nocturnal enuresis ― means passing urine without intending to while asleep. This happens after the age at which staying dry at night can be reasonably expected.

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't get upset if your child wets the bed. Bed-wetting isn't a sign of problems with toilet training. It's often just a typical part of a child's development.

Generally, bed-wetting before age 7 isn't a concern. At this age, your child may still be developing nighttime bladder control.

If your child continues to wet the bed, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medicine may help lessen bed-wetting.

Symptoms

Most kids are fully toilet trained by age 5, but there's really no target date for having complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

When to see a doctor

Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.

Talk to your child's doctor or other health care professional if:

• Your child still wets the bed after age 7.
• Your child starts to wet the bed after a few months of being dry at night.
• In addition to wetting the bed, your child has pain when passing urine, is often extra thirsty, has pink or red urine, has hard stools, or snores.

Causes

It's not known for sure what causes bed-wetting. Several issues may play a role, such as:

• A small bladder. Your child's bladder may not be developed enough to hold all the urine made during the night.
• No awareness of a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child. This may be especially true if your child is a deep sleeper.
• A hormone imbalance. During childhood, some kids do not produce enough anti-diuretic hormone, also called ADH. ADH slows down how much urine is made during the night.
• Urinary tract infection. Also called a UTI, this infection can make it hard for your child to control the urge to pass urine. Symptoms may include bed-wetting, daytime accidents, passing urine often, red or pink urine, and pain when passing urine.
• Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea. Sleep apnea is when a child's breathing is interrupted during sleep. This is often due to swollen and irritated or enlarged tonsils or adenoids. Other symptoms may include snoring and being sleepy during the day.
• Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other symptoms may include passing large amounts of urine at once, increased thirst, extreme tiredness and weight loss in spite of a good appetite.
• Ongoing constipation. A child who is constipated does not have bowel movements often enough, and the stools may be hard and dry. When constipation is long term, the muscles involved in passing urine and stools may not work well. This can be linked to bed-wetting.
• A problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a difference in the structure of the urinary tract or nervous system.

Risk factors

Bed-wetting can affect anyone, but it's twice as common in boys as in girls.

Several factors have been linked with an increased risk of bed-wetting, including:

• Stress and anxiety. Stressful events may trigger bed-wetting. Examples include having a new baby in the family, starting a new school or sleeping away from home.
• Family history. If one or both of a child's parents wet the bed as children, their child has an increased chance of wetting the bed, too.
• Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.

Complications

Although frustrating, bed-wetting without a physical cause does not result in any health risks. But bed-wetting can create some issues for your child, including:

• Guilt and embarrassment, which can lead to low self-esteem.
• Loss of opportunities for social activities, such as sleepovers and camp.
• Rashes on your child's bottom and genital area — especially if your child sleeps in wet underwear.