Sleep Disorders: What Causes Bedwetting?

While bedwetting can be a symptom of an underlying disease, a large majority of children who wet the bed have no underlying disease that explains their bedwetting. In fact, an underlying condition is identified in only about 1% of children who routinely wet the bed.

That does not mean that the child who wets the bed can control it or is doing it on purpose. They are not lazy, willful, or disobedient. Bedwetting is most often a developmental issue. Most kids simply outgrow it and never need treatment.

Types of Bedwetting

There are 2 types of bedwetting: primary and secondary. Primary means bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts up after the child has been dry at night for a significant period of time, at least 6 months.

What Causes Primary Bedwetting?

The cause is likely due to one or a combination of the following:

  • The child cannot yet hold urine for the entire night.
  • The child does not waken when their bladder is full.
  • The child produces a large amount of urine during the evening and night hours.
  • The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can. Parents usually are familiar with the leg crossing, face straining, squirming, squatting, and groin holding that children use to hold back urine.

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What Causes Secondary Bedwetting?

Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting. Common causes of secondary bedwetting include the following:

  • Urinary tract infection. The resulting bladder irritation can cause pain or irritation with urination, a stronger urge to urinate (urgency), and frequent urination (frequency). Urinary tract infections in children may indicate another problem, such as an anatomical abnormality.
  • DiabetesPeople with diabetes have a high level of sugar in their blood. The body increases urine output to try to get rid of the sugar. Having to urinate frequently is a common symptom of diabetes.
  • Structural or anatomical abnormality. An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence or other urinary problems that could show up as bedwetting.
  • Sleep apnea. When your child’s breathing is disrupted, their brain works harder to take in oxygen than it does on other functions, like bladder control. Sleep apnea in children is often caused by enlarged tonsils and adenoids blocking their airway. In that case, removing their tonsils and adenoids can improve their breathing and end the bedwetting. 
  • Neurological problems. Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.
  • Emotional problems. A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting. Children who are being physically or sexually abused sometimes begin bedwetting.

Is Bedwetting Inherited?

Bedwetting does tend to run in families. Many children who wet the bed have a parent who did too. Most of these children stop bedwetting on their own at about the same age their parent did.

When to Call the Doctor

Parents should consider treatment if their child is still wetting the bed between ages 6 and 7, according to the National Enuresis Society -- or sooner if the child seems troubled by bedwetting. In addition, no matter the age, if you notice other symptoms, such as if your child has the urge to urinate more often or has a burning sensation when they pee, get medical care right away.

WebMD Medical Reference Reviewed by Amita Shroff, MD on June 22, 2020

Sources

SOURCES:

eMedicineHealth: "Bedwetting Causes," "Bed-Wetting in Kids."

Thiedke, C. American Family Physician, April 2003.

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