Bedwetting is a familiar problem many people experience at some point. Still, bedwetting can be uncomfortable and upsetting for both children and parents, especially when it happens in older children. If this sounds familiar, you’re not alone.

What Is Bedwetting?

Bedwetting, also called “nocturnal enuresis,” is involuntary urination during sleep in children over five years1 of age. Bedwetting affects five to seven million children in the US and 5 to 10% of all seven-year-olds. Although bedwetting is slightly more common in boys than in girls, it affects children of all genders.

When Is Bedwetting a Problem?

Bedwetting can be expected in young children, but it becomes less common and less frequent with age. Rates of bedwetting in children2 generally drop noticeably around age five, with only 1% of this group wetting the bed nightly. Twenty percent of five-year-olds wet the bed at least once per month, even after they are otherwise potty trained. By adulthood, less than one percent of all people wet the bed at least once per month.

Since each child matures and hits developmental milestones at a different pace, different children stop wetting the bed at different ages. Generally, occasional bedwetting is considered normal in childhood and is nothing to worry about.

• In rare cases, bedwetting indicates an underlying problem. Parents might want to explore medical testing if their children experience any of the following issues3:
• Sudden onset of bedwetting episodes in older children or teenagers after a long period of dry sleeping
• Painful urination
• Cloudy or discolored urine
• Daytime incontinence
• Bowel movement issues, such as constipation or a lack of bowel control
• Sleep issues, such as being unable to be woken up
• Excessive thirst

Potential Causes of Bedwetting

Most bedwetting is normal and doesn’t have any underlying cause. That said, there are a wide range of potential causes that can lead to bedwetting. They include:

• Anxiety: Research shows that children who experience bedwetting are significantly more likely to have anxiety issues4 than children who do not wet the bed. Anxiety can be the result of a chronic, ongoing state of distress or a direct response to a specific stressful condition or event. Children who struggle with bedwetting are more likely to experience generalized anxiety, panic attacks, school phobia, social anxiety, and separation anxiety. If bedwetting is a persistent issue, parents might want to consider having their child checked for an anxiety disorder.
• Eating and drinking habits: Certain foods and drinks are diuretics, which means that they cause the body to produce more urine. Some children are more sensitive to diuretics than others. Caffeine, especially that found in coffee and tea, is a major diuretic. Also, when a child drinks can impact how likely they are to wet the bed. For this reason, many parents restrict their children’s fluid intake5 in the evening as bedtime nears.
• Urinary Tract Infections (UTIs): Sometimes, children wet the bed because they have a urinary tract infection6, or UTI. Common symptoms of a UTI include frequent and unexpected urination, as well as inflammation of the bladder, both of which can cause bedwetting. Though UTIs are easily treatable, they often go initially undiagnosed in children, who sometimes lack the ability to explain their symptoms.
• Sleep apnea: Sleep apnea causes the body to repeatedly stop breathing during sleep. It is relatively common among adults, but recent research has shown that it is found in children as well. One potential effect of sleep apnea is the production of a hormone called “atrial natriuretic peptide” (ANP). ANP causes the kidneys to produce extra urine during sleep, which may lead to bedwetting7.
• Constipation: Constipation causes excess waste to accumulate in the rectum, which can make it bulge. The rectum is located right behind the bladder, so in some cases, a bulging rectum pushes on the bladder. As a result, regular constipation can cause bedwetting. Children experiencing both constipation and bedwetting should treat constipation first, then see if the bedwetting subsides.

Less common, but potentially more severe causes of bedwetting include:

• Kidney Issues: The kidneys play a major role in urine production and disposal, so bedwetting can sometimes be caused by enlarged kidneys or chronic kidney disease. Children with kidney disease might experience weight loss, increased thirst, or increased urination in addition to bedwetting.
• ADH Insufficiency: In a healthy person, the brain produces a hormone called “antidiuretic hormone” (ADH). This hormone slows the rate at which the kidneys produce urine during the night. When there is insufficient ADH production8, or when the body does not properly process or respond to ADH, urine production will not sufficiently slow down at night, which can cause bedwetting.
• Diabetes: Diabetes is caused by insufficient production of the hormone insulin, which helps the body process sugar. In untreated patients, diabetes causes the body to dispose of sugar through the urine, which leads to hyper-frequent urination. One of the most frequent first symptoms of diabetes in children9 is a marked uptick in urination, often including bedwetting.

In addition, certain factors increase the risk of bedwetting, especially in children. These include:

• Family History: Recent evidence suggests that bedwetting is hereditary10. The average child with no family connection to bedwetting has around a 15% chance of struggling with the issue themselves. If a child has one parent who struggled with bedwetting, their risk factor increases to 50%, while a child with two parents who experienced bedwetting has a risk factor of 75%.
• ADHD: Bedwetting is more common in people with ADHD, especially children. While the link between bedwetting and ADHD is not yet fully understood, research shows that kids with ADHD11 do have an increased risk of bedwetting compared to their neurotypical peers.
• Being a “deep sleeper”: Children who wet the bed are often described as “deep sleepers.” Being a particularly deep sleeper can affect the way the body communicates with the brain12 when it comes to urination. A deep-sleeping child may have a harder time developing an effective signaling system that wakes them up when they need to urinate. Instead, the child’s pelvic floor relaxes during sleep, and bedwetting occurs. Brain-bladder control develops naturally over time and will improve with age, but children who are deep sleepers often take longer to become fully continent at night.