Some children over the age of 5 cannot control their bladder when they are asleep and leak urine. Often, bed-wetting (sometimes called “nighttime urine accidents” or “nocturnal enuresis”) stops on its own, without any kind of treatment. But it may be a sign of a medical problem, although that usually is not the case.

There are two kinds of bed-wetting: primary and secondary. Someone with primary bed-wetting has wet the bed at least sometimes since they were a baby. Secondary bed-wetting is when a child starts to wet the bed at least six months after they have learned to control their bladder at night.

Some children who have nighttime urine accidents also have daytime urine accidents. Learn more about daytime urine accidents.

How common is bed-wetting?

It is normal for children under the age of 5 or 6 to wet the bed sometimes. In fact, about 20 percent of 5-year-old children wet the bed. Older children are affected, too: 3 percent of 10-year-olds and up to 1 percent of 18-year-olds wet the bed. Bed-wetting tends to be more common in boys.

Every year, about 15 percent of children who wet the bed outgrow the problem. Treatment may help speed up the process, helping children overcome bed-wetting sooner rather than later.

What causes bed-wetting?

Children do not wet the bed out of laziness or because they do not care. They simply do not have control of their bladder when they are asleep.

Many children with nighttime urine accidents have an overactive bladder and a small bladder capacity. This means that their bladder may have muscle spasms that cause an urge to empty the bladder more often than usual.

Bed-wetting runs in families. Many children who wet the bed have a parent or other relative who did, too.

Other possible causes of nighttime urine accidents include:

• A urinary tract infection
• Diabetes
• Emotional problems and stress
• Abnormalities in the nervous system or the organs, muscles and nerves involved with urination
• Diet
• The effects of certain medicines

What steps can I take to help my child stop wetting the bed?

The most important thing you can do is be patient and understanding. Make sure your child knows that bed-wetting is a temporary problem, and it is not their fault!

If your child wets the bed, these simple steps may help:

• Encourage your child to drink beverages during the early part of the day, and not after dinner.
• Avoid dairy-based foods and salty snacks two to three hours before bedtime.
• Encourage your child to take time to empty their bladder completely before bed. 
• Wake your child up before you go to bed (about two to three hours after your child’s bedtime) and take them to the bathroom to urinate.
• Bed-wetting is more likely to occur when your child is overtired. If your child is not well rested in the morning, an earlier bedtime may be worth a try.

If these steps do not work and your child wants to stop wetting the bed, consider making an appointment with your pediatrician.

What are the signs that we might need a doctor’s help?

Occasional bed-wetting is common, and typically does not have a negative impact on children. But if your child is wetting the bed often, it can cause embarrassment and shame. Your child may avoid social activities such as slumber parties.

The good news is that treatment is available for children who are motivated to stop wetting the bed. Children who overcome bed-wetting often have a much brighter outlook on life than they did before. They develop a greater sense of self-confidence and flourish in other areas of their lives.

Children younger than seven generally lack the desire and maturity to focus on a bed-wetting program. But if your child is at least 6 years old, still wets the bed and wants to do something about it, it may be time to seek help.

The first person to call is your child’s pediatrician. They will provide a complete physical and run some simple tests to rule out problems such as diabetes or a urinary tract infection. If these tests come back normal, the doctor may refer you to a pediatric urology practice, where doctors and nurse practitioners specialize in treating children who have problems with their urinary system.

Families also can self-refer to the Healthy Bladder Clinic at Cincinnati Children’s by simply calling 513-636-4975 or emailing pedsurology@cchmc.org.

Are there additional tests that a pediatric urology provider might order?

The most important and valuable test that a pediatric urology provider uses to diagnose bed-wetting is something families do at home: keep a “voiding diary.” A voiding diary is a log that parents use to record what their child drinks and when they empty their bladder over the course of three days.

The pediatric urology provider also may order a post-void residual assessment (PVR). This simple ultrasound test can show how much urine is left in the bladder after the child urinates.

These tests help the doctor narrow down the cause of bed-wetting and develop a treatment plan.

What treatment is available?

Treatment for bed-wetting begins with changing behaviors, such as limiting beverages before bed and avoiding certain foods (see “What steps can I take to help my child stop wetting the bed?” in this Health Topic). Sometimes the doctor also may prescribe medicines, a bed-wetting alarm, or both.

The doctor may prescribe medicine that allows the child to have dry nights on special occasions, such as when going to sleepovers and camps. This medicine provides a man-made version of the hormone ADH, which our body uses to slow down the amount of urine made during the night.

Bed-wetting alarms use a special moisture sensor that attaches to your child's underwear. The sensor triggers a bell or buzzer the moment your child begins to urinate at night. This wakens the child so they can get to the toilet and empty their bladder (sometimes a parent wakens first and then wakes up the child). Soon, your child won’t need the alarm − they will get up on their own to use the bathroom or hold their urine until morning. Bed-wetting alarms can take up to three months to work, but they often are effective.

The Healthy Bladder Clinic at Cincinnati Children’s provides comprehensive treatment for children with bed-wetting issues. If your community does not have such a specialty clinic, an appointment with a pediatric urologist or a nephrologist (physician who specializes in treating kidney disorders) may be helpful.

Can bed-wetting be a sign of an underlying medical problem?

Very rarely, bedwetting is a sign of an “acute” problem that requires immediate treatment, such as a urinary tract infection or undiagnosed Type 1 diabetes. Contact your child’s pediatrician if your child:

• Suddenly starts wetting the bed after being consistently dry for at least six months
• Begins to wet their pants during the day
• Snores at night
• Complains of a burning sensation or pain when urinating
• Has to urinate often
• Is drinking or eating much more than usual
• Has swelling of the feet or ankles