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Nocturnal Enuresis (Bedwetting)

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What Is Nocturnal Enuresis (Bedwetting)?

When children pass urine without control while they sleep, it is called nocturnal enuresis. It's also known as bedwetting.

Most children can control their bladder during the day and night by the age of five. Bedwetting is above 10% among six-year-olds, around 5% among 10 year-olds and 0.5-1% among teenagers and young adults, as they have day or nighttime "accidents." If a child experiences bladder control problems during sleep after the age of five and it is bothersome to them and your family, it's worth looking into. Your doctor can help.

Nocturnal enuresis is common for more than five million children in the U.S. It is slightly more common in boys than in girls, and is more common in children who also have behavioral or psychiatric disorders. This issue can be frustrating for children, parents and doctors, and can lead to or exacerbate social anxiety, depression and isolation from peers. As children spend more nights away from home (at camps, sleepovers and field trips), it is of great value to look for solutions. With patience and tools for treatment, most children will stop bedwetting.

There are two types of nocturnal enuresis. The testing, care and treatment for both types are very similar:

  • Primary nocturnal enuresis describes children who never achieved dry nights since potty training (typically these children have no accidents during the day time)

  • Secondary nocturnal enuresis is when a child achieved consistent dry nights for at least six months but has started bedwetting again. This can be related to many factors, including voiding dysfunction, constipation, neurologic

Contact your pediatrician if your child is experiencing either of these types of nocturnal enuresis.

Diagram of the Male and Female Urinary Tracts

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How Does the Urinary System Work?

Urine is liquid waste from your body. Urine forms when the kidneys clean your blood. The "urinary tract" includes the organs in your body that make, store and remove urine.

Normally, the kidneys make about 1½ to 2 quarts of urine each day in an adult (less in children). Urine travels from the kidneys to the bladder through the ureters (the tubes that join them). The bladder has the job of storing and releasing urine. The muscular neck of the bladder stays closed in order to store urine. The urethra is the tube that carries urine from the bladder, out of the body. This area is kept closed with sphincter muscles.

The brain works with the bladder to control when to release urine. Once you are ready to release urine (i.e. in a toilet), the brain sends a signal to the bladder. Then the bladder muscles contract. This pushes urine out of the bladder, through the urethra. The sphincter muscles open and urine is released out of the body.

At first, infants release urine in an uncontrolled way by a simple reflex. As infants grow, many things develop to allow them to gain control over the way their bladder empties:

  • The bladder grows to hold more urine volume with age. 
  • By age two to three years, the child gains control over the sphincter and pelvic floor muscles. When they squeeze these muscles, children can hold the flow of urine until they reach a toilet. 
  • The brain matures with age to allow children to relax or squeeze these muscles at all times. This is when they become "toilet trained." 
  • By age seven, 90% of children can control their bladder both day and night. If they have to use the bathroom at night, they will wake up and go.

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