When is Bedwetting a Problem?

When it comes to wetting the bed, it can be hard for parents to know when they should consult a pelvic rehab professional. Most of us have dealt with bedwetting one way or another, so it can be hard to identify when it goes from being a part of growing up to something more serious. Here are some quick facts:

  • Bedwetting affects 15% of girls and 22% of boys, or 5 – 7 Million US children
  • Boys are 50% more likely than girls to wet the bed
  • 10% of 6 year olds continue to wet
  • Spontaneous cure rate 15% per year thereafter
  • 1-3% of 18 year olds still wet their beds
  • The majority of bedwetting children also experience daytime “accidents” or constipation.
  • Bedwetting is genetic – if one parent was a bed wetter the child has a 40% chance of wetting the bed and if both parents were bedwetters the percentile goes up to 77%

It’s important to know that bedwetting is not behavioral; your kid isn’t lazy and they aren’t just trying to get attention. Sometimes it can be caused by hormone deficiency, sleep apnea, or issues with bowel incontinence. Let’s dive into that a bit.

The Effects of Anxiety and Stress

In a 2016 study, Salehi et al. found that children who wet the bed have a high frequency of generalized anxiety disorder as well as panic disorder, school phobia, social and separation anxieties, maternal anxiety, and a high body mass index.

Impacts of Bowel Difficulties

Dr. Steven Hodges has researched and written extensively on the topic of constipation causing pressure from the rectum against the bladder making it irritable during sleep. His research indicates that emptying the bowels regularly will reduce bedwetting. His book, “See It’s No Accident” is an excellent resource for parents looking for practical advice on children’s toileting issues.

Sleep Troubles

Dr. Neveus and colleagues reported that 43.5% of bedwetting children who also snore or have obstructive sleep apnea became dry after having their tonsils and adenoids removed (this operation is called an adenotonsillectomy).

Hormone Deficiency

Our bladders empty about every 2-3 hours during the day however at night we can hold for over 8 hours! This happens because our bodies produce an antidiuretic hormone when we sleep to slow kidney function and produce less urine to empty into the bladder. If this hormone is not being produced, the kidneys produce as much urine at night as they do during the day. In this case, it’s good that the bladder empties out in our sleep, otherwise our bladders would be dangerously large and possibly reflux urine backward into the kidneys. A synthetic hormone has been created, called Desmopressin acetate (DDAVP), that can be used to slow kidney function while we sleep. Bedwetting is a condition that affects millions of children throughout the world, and there is help available.

If your child is still wetting the bed by the age of 6, it’s time to consult a pediatric pelvic rehabilitation practitioner.


References and further reading:

Al- Zaben FN, Sehlo MG. Punishement for bedwetting is associated with child depression and reduced quality of life. Child Abuse Negl. 2014

Hodges SJ, Colaco M. Daily enema regimen is superior to traditional therapies for nonneurogenic pediatric overactive bladder. Global Pediatric Health, 2016, 3: 1–4

Austin, P., Bauer, S.B., Bower, W., et al. The standardization of terminology of lower urinary tract function in children and adolescence: update report from the standardization committee of the international children’s continence society. J Urol (2014) 191.

Treatment response of an outpatient training for children with enuresis in a tertiary health care setting. J Pediatr Urol. 2012.

Hodges SJ,Anthony EY::aunrecognizedof. Urology.2012 Feb;79(2):421-4. doi: 10.1016/j.urology.2011.10.015. Epub 2011 Dec 14.

Kovacevic L, Wolfe-Christensen C, Lu H, Toton M, Mirkovic J, Thottam PJ, Abdulhamid I, Madgy D, Lakshmanan Y. Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing? J Urol. 2014 May;191(5 Suppl):1592-6.

Nevéus T, Leissner L, Rudblad S, Bazargani F. Acta Paediatr. 2014 Jul 15. doi: 10.1111/apa.12749. [Epub ahead of print]Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis.

Hodges, Steve J. It’s No Accident-Breakthrough solutions for your child’s wetting, constipation, UTI’s and other potty problems. © 2012. Lyons Press, Guilford, Connecticut.

Salehi, B., Yousefichaijan, P., Rafeei, M., & Mostajeran, M. (2016). The Relationship Between Child Anxiety Related Disorders and Primary Nocturnal Enuresis. Iranian Journal of Psychiatry and Behavioral Sciences, 10(2), e4462. http://doi.org/10.17795/ijpbs-4462