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What is bedwetting? -

Bedwetting, or nocturnal enuresis, is when a person accidentally or involuntarily pees during sleep.

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Who does it affect? -

Bedwetting primarily affects children, especially between the ages of four and six. Most children stop this as they grow older and learn how to better control their bladders, but this is not always the case.

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Who does it affect? -

The condition is more common among boys than girls. Adults can suffer from it too, though the underlying causes are often dufferent, namely medical or psychological conditions.

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Types of nocturnal enuresis: primary -

There are two types of bedwetting, one of them is called primary. This is when the person has wet the bed for six months in a row or longer.

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Types of nocturnal enuresis: secondary -

The secondary type of bedwetting occurs when an individual wets the bed again after not doing so for a period of six months or more.

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How common is bedwetting? -

In the US, it’s estimated that about 1 in 10 children have nocturnal enuresis. It mostly affects children ages 7 and under. Nocturnal enuresis is rarer in adults, with only about  2% to 3% of adults suffering from it. 

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Symptoms -

There is only one main symptom of nocturnal enuresis, which is waking up with wet clothes and/or sheets. There is usually a feeling of embarrassment or shame associated with it, but in terms of physical symptoms, it’s just peeing in bed during sleep. 

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Possible underlying medical conditions -

Bedwetting can, however, be a symptom of an underlying medical condition. Some of the signs to look for include changes in urination frequency during the day, and changes in the stream of urine (smaller than usual).

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Possible underlying medical conditions -

Other things to consider include changes in urine color, lack of bowel movements, and painful urination.

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Causes in childhood -

Children often stop wetting their beds by around age seven, but occasional episodes may occur. Sometimes, they may be linked to underlying medical conditions such as urinary tract infection, diabetes, constipation, or spina bifida.

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Causes in childhood -

Other possible underlying medical conditions that lead to episodes of nocturnal enuresis include ADHD, a narrow urethra or urinary tract blockage, or even obstructive sleep apnea.

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Causes in adulthood: genetic -

Those aged 18 and over may also have nocturnal enuresis. One of the possible underlying causes is genetics. Some people inherit a genetic predisposition to bedwetting. In such cases, it’s not uncommon for the parents to have also suffered from bedwetting.

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Causes in adulthood: hormonal -

Adults may wet the bed if their production of vasopressin is below normal. This antidiuretic hormone is key in limiting the amount of urine produced during sleep.

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Causes in adulthood: bladder -

Those with a small functional bladder capacity feel the urge to pee more frequently, and as such, are more likely to involuntarily release urine during sleep.

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Causes in adulthood: failure to wake up -

When the bladder gets full, it sends a signal to the brain to wake the person up, which is what usually happens. Sometimes the person fails to wake up (e.g. due to medication), and bedwetting may occur.

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Causes in adulthood: constipation -

Constipation is also a possible cause of bedwetting in adults. The pressure caused by a lack of bowel movements can interfere with the nerve signals between the bladder and the brain. It may also prevent the bladder from emptying fully.

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Causes in adulthood: psychological or emotional issues -

Stressful and traumatic events may lead to episodes of bedwetting. Big changes in one’s life, such as divorce, moving to a new home, or the death of a loved one, etc., may trigger such episodes.

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Causes in adulthood: medical conditions -

In addition to the aforementioned possible causes, there are a number of other medical conditions that may be responsible for nocturnal enuresis, including a number of bladder and kidney issues, neurological changes, and sickle cell disease.

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Diagnosis -

A healthcare provider may conduct a physical exam and request a number of tests, including urine and a blood test. Imaging tests may also be used to rule out any underlying medical conditions.

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Diagnosis -

If there’s a suspicion that the bedwetting is caused by a psychological issue, then the healthcare provider may refer the patient to a mental health professional.

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Treatment: behavioral changes -

While treatment for nocturnal enuresis will vary depending on the underlying cause, some behavioral changes are usually recommended. One of these techniques involves limiting the amount of fluids at least two hours before going to bed.

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Treatment: empty the bladder before bedtime -

Another habit that can be implemented is ensuring the person goes to the bathroom before going to bed. Some children may not feel like peeing, but it’s important that they try to empty their bladder before bedtime.

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Treatment: enuresis alarm -

Enuresis alarms have moisture sensors and they work by waking up the person just as they start releasing urine. Over time, this will train the brain to wake up before peeing.

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Treatment: bladder therapy -

The idea is to increase the bladder’s capacity by delaying the frequency of going to the bathroom during the day. This will train the bladder to hold urine for longer periods of time more efficiently.

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Treatment: medication -

When bedwetting is caused by a medical condition sometimes medication is prescribed. This may include taking medication to reduce urine production during the night.

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Treatment: medication -

Common types of medications include synthetic versions of the hormone vasopressin, as well as medication that reduces bladder contractions, which is used to treat an overactive bladder.

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Treatment: medication -

Other medications that can be helpful in treating nocturnal enuresis include imipramine, a drug used to treat depression but that's also effective against bedwetting in children. Anticholinergic medications, which control nerve impulses, may also be prescribed.

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Treatment: therapy -

If the bedwetting is triggered by psychological factors, then some form of therapy may be recommended.

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Treatment: surgery -

Adults who have tried everything else without success may undergo surgery as a last resort. The procedure can improve bladder contractions.

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What else can I do if my child or a loved one wets the bed? -

In addition to the aforementioned behavioral changes, it’s very important not to make fun of or shame the person who has nocturnal enuresis.

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When should you see a healthcare provider? -

If you have any questions or concerns about you, your child, or a loved one, you should seek professional help. Some things to look for include it happening during daytime, and new episodes after a long time of not wetting the bed.

Sources: (Cleveland Clinic) (Mayo Clinic) (Urology Care Foundation)

See also: Incontinence and the embarrassment it causes

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