Parasomnias
Bedwetting (Sleep Enuresis)
Involuntary urination during sleep in children aged 5 or older. It is common, not the child's fault, and usually improves with time and treatment.
Overview
Bedwetting, or sleep enuresis, is involuntary urination during sleep in a child aged five or older. Primary enuresis means the child has never been consistently dry at night. Secondary enuresis means bedwetting returns after at least six months of being dry.
Bedwetting is common and is not caused by laziness or bad behaviour. It often runs in families and is related to deep sleep, a bladder that holds less at night and producing more urine overnight.
Most children outgrow it, and effective treatments such as bedwetting alarms and medication are available. New bedwetting after a dry period can sometimes signal another problem, such as constipation, a urinary infection, diabetes or obstructive sleep apnea.
About 5% to 10% of seven-year-olds have enuresis, according to a review in American Family Physician.
Common symptoms
- Wetting the bed during sleep at age 5 or older
- Wetting that happens most nights or a few times a week
- Returning to bedwetting after a dry period (secondary)
- Embarrassment or reluctance to attend sleepovers
- Sleeping very deeply and being hard to wake
Causes and risk factors
- Family history of bedwetting
- Producing more urine at night
- Smaller nighttime bladder capacity or an overactive bladder
- Difficulty waking to bladder signals
- Constipation
- Obstructive sleep apnea
- Urinary tract infection or diabetes (especially with secondary enuresis)
- Stress or major changes
How it is diagnosed
A clinician takes a history, examines the child and usually checks a urine sample for infection or sugar. Parents may be asked to keep a bladder and fluid diary. Further tests are needed only if there are daytime symptoms, constipation, snoring or signs of another condition.
Treatment options
Bedwetting alarm
A moisture-sensitive alarm wakes the child at the first drops, gradually training them to wake or hold urine. It is a first-line option with lasting benefit.
Desmopressin
A prescription medicine that reduces nighttime urine production, useful for sleepovers or when an alarm is not suitable.
Treating constipation
Can resolve or reduce bedwetting in some children.
Treating sleep apnea
Enlarged tonsils and adenoids causing OSA can contribute to bedwetting.
Supportive routines
Regular daytime toilet trips and emptying the bladder before bed.
What you can do yourself
- Reassure your child that it is common and not their fault
- Encourage regular drinks during the day and fewer in the hour or two before bed
- Have your child use the toilet before bed
- Avoid caffeinated drinks such as cola
- Use waterproof mattress covers and keep clean bedding accessible
- Never punish a child for wetting
When to see a doctor
- Your child is 7 or older and still wets the bed regularly
- Bedwetting starts again after six months of being dry
- There is pain on urination, daytime wetting, excessive thirst or weight loss
- Your child snores or has breathing pauses
- Bedwetting is causing your child distress
Frequently asked questions
At what age is bedwetting a concern?
Bedwetting is not considered a medical problem before age 5. Many clinicians start active treatment around age 6 or 7, or earlier if it bothers the child.
Do bedwetting alarms work?
Yes. Alarms are one of the most effective treatments and often have lasting results, but they require consistent use for several weeks and parental support.
Can sleep apnea cause bedwetting?
Yes. Obstructive sleep apnea, often from enlarged tonsils and adenoids, is linked to bedwetting, and treating it can improve wetting in some children.
Should I wake my child at night to use the toilet?
Lifting a sleeping child to the toilet may keep the bed dry that night but does not teach the child to wake on their own. Alarms and other treatments are more effective long term.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.