Bed Wetting Causes

For kids with primary nocturnal enuresis (PNE), there are two primary bed wetting causes. First, they need to urinate at night. Second ...

Question

Dear Dr. Greene, My eight year old son has wet the bed consistently for as long as I can remember. He feels terrible about it and I feel like a failure as a parent. My mother says it is because he has emotional problems. What are the real bed wetting causes? Does anybody know?

Dr. Greene's Answer

Children who can control their bladders during the day, but who have never been dry at night for at least a six month period, have what is known medically as primary nocturnal enuresis (PNE), the most common form of bed-wetting. Over five million school-age children in the US alone have PNE. What are common bed wetting causes?

Sadly, most children with PNE feel that there is something wrong with who they are that causes their problem. Many of them feel that it’s the result of either bad thoughts or bad actions. They feel that somehow bed-wetting is a punishment.

Similarly, many parents feel that their children’s bed-wetting is a result of a defect in their parenting. This feeling is heightened by well-meaning friends and relatives who bring up questions of emotional instability as the cause of bed-wetting.

In a recent survey of 9,000 parents of kids ages 6 – 17, 22% stated that they thought the reason their child wet the bed was laziness (survey conducted by ICR Survey Group from July 10, 1996, through August 6, 1996). I am happy to tell you that this could not be further from the truth! Primary nocturnal enuresis is a common developmental phenomenon related to physical and physiologic factors. It does not come from emotional stress, poor self-esteem, or emotional immaturity.

Bed Wetting Causes

Children with PNE have two things in common. First, they need to urinate at night. Not all children do. During the first months of life, babies urinate around-the-clock. Most adults, however, don’t need to urinate at night (although a small percentage of the population will need to urinate at night throughout life). Sometime in middle childhood, most individuals make the transition from urinating around-the-clock to only urinating during waking hours. There are three reasons why individuals continue to need to urinate at night:

  1. There is an imbalance of the bladder muscles. For example, the muscle that contracts to squeeze the urine out is stronger, at moments, than the sphincter muscle that holds the urine in.
  2. They have bladders that are a little too small to hold the normal amount of urine.
  3. They make more urine than their normal-size bladders can hold, for several reasons:
    • They may drink too much. Drinking in the two hours before bed increases nighttime urine production.
    • They may be consuming a diuretic medication, a substance that directly increases urine output. Usually these are not prescribed medications, but caffeinated cola drinks or chocolate.
    • They may make more urine in response to a chronic disease such as diabetes or a chronic urinary tract infection.
    • They may make more urine than average because of their hormonal regulatory systems. Babies make about the same amount of urine around-the-clock. Most adults make less urine while they sleep. The reason for this is thought to be a nighttime surge of a hormone called Antidiuretic Hormone (ADH). The levels of ADH found in the blood are higher beginning in the evening. One study looking at ADH levels in bed wetters, compared to controls, found that there was a constant low level of ADH in the bed wetters. The nighttime surge did not happen. Perhaps this is a reason bed wetters tend to make more urine at night.

If an individual consistently has to urinate at night, one or more of the above three reasons is the cause. The second thing children with PNE have in common is that they don’t wake up when they need to urinate. When infants need to urinate, there is no signal that goes from the bladder to the brain to wake them up. This is wonderful, since they are not yet able to walk to the bathroom and use the toilet! On the other hand, when an adult’s bladder is full at night, there is a signal that goes from the bladder, through the nervous system, up to the brain. This initiates a dream about water, or more specifically, about going to the bathroom. The dream alerts our reticular activating system, which awakens us. We can then get out of bed, walk to the bathroom, and use the toilet. This signaling mechanism comes into play sometime in middle childhood.

For many years, parents of bed-wetting children have claimed that their children were deep sleepers. Physicians have usually disagreed with this, citing evidence from sleep EEGs showing that bed-wetting children went through the same stages of sleep as other children, at the same frequency, and that bed-wetting can occur at any stage of sleep.

I have never heard a parent come in and say, “My child spends too much time in stage four sleep.” They just say that their children are deep sleepers and are difficult to wake up. About a decade ago, researchers in Canada performed a simple, but powerful, study where they put headphones on children in a sleep lab. They began the study by allowing the children to get used to sleeping with the headphones on. Then they began introducing tones through the headphones. They measured the minimum volume it took to wake each child. The study showed that the children in the bed-wetting group were dramatically more difficult to wake up than normal controls — confirming what parents have known for years!

Children who wet the bed at night both need to urinate at night and do not wake up when their bladders are full. These are the only children who wet the bed.

Understanding the causes of bed-wetting can help remove its stigma. You are also now better equipped to evaluate the suggestions people make to you. Effective therapy is aimed at the underlying causes. Most children can be completely dry within 12 weeks.

N.B. As I stated in my earlier answer titled, “Is bed-wetting genetic?”, there is help for children who wet the bed! The biggest hindrances to getting help are the absence of a skilled, empathetic physician, and shame — parents and children are ashamed to bring the subject up with someone who can help. It is up to you to take the first step! Talk with your doctor. If you find that for some reason she or he is not able to get your child dry quickly and effectively, I would call the closest Children’s Hospital to find out who treats bed-wetting issues.

Last medical review on: January 19, 2011
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Hi Ethel,

Thanks for writing in.

I’m sure yoiu’ve tried a lot of different methods to help your son. Did you see Dr. Greene’s Q&A about Bed Wetting Treatments? Which of these treatments have you tried and how did they work for you?

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

My son is 14 years old and he is still wetting bed what can I do plis help

Hi Ethel,

Thanks for writing in.

I’m sure yoiu’ve tried a lot of different methods to help your son. Did you see Dr. Greene’s Q&A about Bed Wetting Treatments? Which of these treatments have you tried and how did they work for you?

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Ruth,

How discouraging! It sounds like you need to see a urologist who specializes in enuresis. You can likely find one by calling a major hospital in your area and asking to be transferred to the urology department. They will likely know where to direct you from there.

I hope that helps.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hello Dr Greene

I’m 22 and I bed wet. I’ve tried everything i can and have run out of ideas. Sometimes I even deprive myself of water at night and starve just to make sure my bladder is really empty before bedtime. I don’t know what more to do. I need help please.

Ruth,

How discouraging! It sounds like you need to see a urologist who specializes in enuresis. You can likely find one by calling a major hospital in your area and asking to be transferred to the urology department. They will likely know where to direct you from there.

I hope that helps.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Omotolani,

Occasional bedwetting may be a sign of undiagnosed urinary tract infection or an unusually deep sleep due to illness. Do you remember the circumstances of either occasion? Did you have a mild fever or were you under unusual pressure or had you been overtired for some reason?

If this happens again, and it may not ever happen again, reflect on your physical condition. If it’s related to an illness you may need to be treated for the illness.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hello Dr Greene,In a long while now I haven’t bedwetted since, except when I was in school once in my life when I was 16 now again this November 6 I bedwetted and I woke up few hours before dart time without any signal of me wanting to urinate .I feel really bad I couldn’t tell anyone cos I am so very much ashamed of my IQ

Omotolani,

Occasional bedwetting may be a sign of undiagnosed urinary tract infection or an unusually deep sleep due to illness. Do you remember the circumstances of either occasion? Did you have a mild fever or were you under unusual pressure or had you been overtired for some reason?

If this happens again, and it may not ever happen again, reflect on your physical condition. If it’s related to an illness you may need to be treated for the illness.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

I know this doesn’t help, but my heart goes out to you. What have you tried?

My names Katherine. I’ve never shared my story except with my husband. I was so severely abused (beaten with a belt) for potty accidents and bedwetting that I’m actually afraid of the bathroom and I have to talk myself into going to the toilet when I need to. The fear is so awful and crippling. I think partly because of this fear I never totally stopped having accidents in my pants because I would hold and hold, desperate to avoid the bathroom. I also still wet the bed more often then not. Literally realizing I need to pee can bring on a huge panic attack and I have to try to calm down and get thru that and then force myself to go to the toilet. But sometimes by the time I can make myself go in, its too late and then I sometimes have flashbacks of the beatings I got every time I had an accident. My husband and I have 2 kids, ages 8 and almost 5. Girl and boy. My hubby handled the toilet training almost totally on his own. It was way too triggering for me and I didn’t want my babies to end up as afraid as I was. My son trained fully, day and night by 3. My 8 year old daughter still struggles a little with waiting too late but its definitely made her more compassionate. The other day I was triggered so bad with flashbacks etc and I was just too scared to go pretty much all day. I ended up crying cuz I knew if I didn’t pull it together soon, I was going to go in my pants. I had to both pee and poop BAD. But i just couldn’t do. I was so panicked. Finally I tried again. 430 pm. Hadn’t gone since the night before when I woke up wet. I tried. Ran to the bathroom. Too late. The all too familiar feeling of my panties getting wet and urine pouring down my leg. The poop came at the same moment. Too fast for me to hold it back. It was soft and very messy. I started crying. I hate everything about this. At that moment my kids came home from school. My daughter heard me crying and saw my soaked pants. “Its okay, mommy. Remember I had an accident at school last week. You just need dry pants.” So sweet and matter of fact. Then goes and brings me back some pants, underwear and socks. I’d give anything to get past this and have fewer accidents. 😢

I know this doesn’t help, but my heart goes out to you. What have you tried?

There are several different treatments. But it means talking to your doctor to get help. There are medicines like DDAVP and alarms that vibrate and make a loud noise to wake you up as soon as a few drops of moisture hit the sensor. If your doctor doesn’t know what to do, ask to be referred to a urologist who deals with bedwetting.

BTW — the medical name is enuresis (pronounced in-your-reece-is). You can look that up on a site that has pronunciations and tell the scheduler that’s why you want to see the doctor.

Hi Octavia,

How hard — on everyone.

Dr. Greene is a big advocate of Bed Wetting Alarms. Seven is a good age to use an alarm. They take a lot of work and a commitment to using one consistently. In the long run, everyone will be happier.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.