Bed wetting ( Nocturnal Enuresis ): Causes, Risk Factors, and Treatments

Overview

Bedwetting is the loss of bladder control during the night. The medical term for bedwetting is nocturnal (nighttime) enuresis. Bedwetting can be an uncomfortable issue, but in many cases it’s perfectly normal.

Bedwetting is a standard developmental stage for some children. However, it can be a symptom of underlying illness or disease in adults. About 2 percent of adults experience bedwetting, which can be attributed to a variety of causes and may require treatment.

Causes of bedwetting

Physical and psychological conditions can lead to some people having bedwetting. Common causes of children and adults having bedwetting include:

• small bladder size
• urinary tract infection (UTI)
• stress, fear, or insecurity
• neurological disorders, such as being post-stroke
• prostate gland enlargement
• sleep apnea, or abnormal pauses in breathing during sleep
• constipation

Hormonal imbalances can also cause some people to experience bedwetting. Everyone’s body makes antidiuretic hormone (ADH). ADH tells your body to slow down the production of urine overnight. The lower volume of urine helps a normal bladder hold urine overnight.

People whose bodies don’t make sufficient levels of ADH may experience nocturnal enuresis because their bladders can’t hold higher volumes of urine.

Diabetes is another disorder that can cause bedwetting. If you have diabetes, your body doesn’t process glucose, or sugar, properly and may produce larger amounts of urine. The increase in urine production can cause children and adults who normally stay dry overnight to wet the bed.

Risk factors for bedwetting

Gender and genetics are among the main risk factors for developing bedwetting in childhood. Both boys and girls may experience episodes of nocturnal enuresis during early childhood, usually between ages 3 and 5. But boys are more likely to continue to wet the bed as they get older.

Family history plays a role, too. A child is more likely to wet the bed if a parent, sibling, or other family member has had the same issue. The chances are 70 percent if both parents had bedwetting as children.

Bedwetting is also more common among children diagnosed with attention deficit hyperactivity disorder (ADHD). Researchers don’t yet fully understand the relationship between bedwetting and ADHD.

Lifestyle changes to manage bedwetting

Certain lifestyle changes may help end bedwetting. For adults, setting limits on fluid intake plays a large part in controlling bedwetting. Try not to drink water or other liquids within a few hours of bedtime to reduce the risk of having an accident.

Drink the majority of your daily fluid requirements before dinnertime, but don’t limit your overall intake of liquids. This will ensure that your bladder is relatively empty before bedtime. For children, limiting fluids before bedtime has not been shown to reliably decrease bedwetting.

Try to also cut out caffeinated or alcoholic drinks in the evening. Caffeine and alcohol are bladder irritants and diuretics. They’ll cause you to urinate more.

Using the bathroom right before you go to bed to empty your bladder fully before sleep can help as well.

In children

A stressful event in a young person’s life can sometimes cause bedwetting. Conflict at home or school may cause your child to have nightly accidents. Other examples of situations that can be stressful to children and may trigger bedwetting incidents include:

• the birth of a sibling
• moving to a new home
• another change in routine

Talk to your child about how they’re feeling. Understanding and compassion can help your child feel better about their situation, which can put an end to bedwetting in many cases.

But a child who develops bedwetting but has already been dry at night for over 6 months could signal a medical problem, too. Talk to your child’s doctor about any new bedwetting that does not resolve itself within a week or so, or is accompanied by other symptoms.

Refrain from punishing your child for bedwetting incidents. It’s important to have open and honest conversations with them about bedwetting. Reassuring them that it’ll stop eventually can be helpful.

Also, allowing and encouraging your child to take as much responsibility as is appropriate for their age is good too. For example, keep a dry towel to put down and a change of pajamas and underwear by the bed for them to change into if they wake up wet.

Working together helps create a nurturing and supportive environment for your child.

While having bedwetting can be normal in younger children, talk to your pediatrician if your child is over the age of 5 years old and still has bedwetting a few times per week. The condition may stop on its own by the time your child reaches puberty.

Medical treatment for bedwetting

Bedwetting that stems from a medical condition requires treatment beyond just lifestyle adjustments. Medications can treat a variety of conditions of which bedwetting is a symptom. For example:

• Antibiotics can eliminate UTIs.
• Anticholinergic drugs can calm an irritated bladder.
• Desmopressin acetate increases levels of ADH to slow nighttime urine production.
• Medications that block dihydrotestosterone (DHT) can reduce swelling of the prostate gland.

It’s also important to control chronic conditions, such as diabetes and sleep apnea. Bedwetting associated with underlying medical issues will likely resolve with proper management.

Takeaway

Most children start outgrowing bedwetting after 6 years old. By this age, bladder control is stronger and more fully developed. Lifestyle changes, medical treatment, and support from family and friends can help children and adults overcome bedwetting.

While bedwetting can be overcome with lifestyle modifications, you should still see a doctor to rule out any possible underlying medical causes. Also, see your doctor if you’ve never had bedwetting but have recently developed it as an older adult.