Enuresis is a pattern of urinating in inappropriate places, such as in bed or into clothes, after the age of 5 years old, the point at which children normally develop control of their bladder. Most of the time, the episodes are involuntary, but they can also be intentional. An estimated 5 to 10 percent of 5-year-olds experience enuresis, along with 3 to 5 percent of 10-year-olds and 1 percent of 15-year-olds, according to the DSM-5. This condition usually ends by adolescence, but in roughly 1 percent of children, it continues into adulthood. Enuresis can be distressing and a source of embarrassment, but it is not physically harmful.
For a diagnosis of enuresis, according to the DSM-5:
- A child urinates—involuntarily or intentionally—in bed or into clothes.
- This occurs at least twice a week for three months in a row or causes significant distress or impairment in functioning.
- The child is at least 5 years old (or at an equivalent level of development).
- This behavior must not be attributable to a substance's physiological effects or another medical condition.
Enuresis may affect children who have never established urinary continence as well as those who established continence prior to experiencing wetting incidents.
The level of impairment that results from enuresis can vary based on such factors as its effect on a child's self-esteem and social activity and the degree of negative response from caregivers.
Nocturnal enuresis is the most common form and is defined as incontinence only during nighttime sleep. Diurnal enuresis, the voiding of urine only during waking hours, may occur when a child experiences sudden urges to urinate or because they consciously postpone urination. A combination of nocturnal and diurnal enuresis can also occur.
Many children who wet the bed feel shame and embarrassment, especially around potential odor problems. They may try to hide dirty sheets and underwear or avoid sleepovers out of fear that a friend will discover their secret. Bedwetting can sometimes create problems in the child’s relationship with their parents, particularly if the parents feel guilty and blame either themselves or their child for this condition. Some practical advice for parents dealing with bedwetting includes getting their child on a regular sleep schedule, rewarding the dry nights, and ignoring the bedwetting incidents as much as possible.
Enuresis is associated with delayed development of the circadian rhythms of urine production. Children whose parents experienced enuresis are more likely to have nocturnal enuresis, and research shows that the risk of having the condition is influenced by genetics.
Inadequate toilet training and stress have also been posited as factors that predispose a child to enuresis, according to the DSM-5.
While most children demonstrate readiness for toilet training between ages 18 to 30 months, each child is different. A few indications for parents to look for include independence (e.g., a child’s ability to say “no”) and interest (e.g., the child follows the parent to the bathroom). A child must be able to take their clothes off and put them back on, walk, and sit down by themselves. They should also be able to differentiate between when they are urinating and when they feel the urge to urinate.
A sudden regression to bedwetting behaviors can be a sign of extreme stress, grief, or trauma. During major transitions, children will sometimes revert to old behaviors they had outgrown, including enuresis. In rare cases, wetting the bed can be a sign of serious emotional upheaval in children who have lost a loved one, witnessed domestic violence, or been sexually abused.
No. In the past, bedwetting, along with setting fires and being cruel to animals, was considered a potential sign of sociopathy, a theory called MacDonald's triad; however, not enough research exists to make this claim. In most cases, enuresis is a temporary, involuntary condition that a child outgrows; it has nothing to do with whether or not they are high in sociopathy or any other psychiatric disorders. Rather, wetting the bed is more likely to indicate that a child has deep feelings they’re struggling to express or a need for attention and care that is not currently being met.
Neither punishing a child for wetting nor ignoring it is helpful, according to guidance from the U.S. National Library of Medicine's MedlinePlus. Instead, parents should take a patient approach to helping children establish urinary continence. This can include encouraging a child to go to the bathroom at regular times—including before bed—and to not hold urine for an extended period. Parents may also reward a child for nights without bedwetting and praise efforts to try. A bedwetting alarm can also be purchased to alert a child who begins to urinate to use the restroom.
A child's health care provider can identify causes of wetting, determine whether it is related to any other condition, and recommend treatment. As one part of treatment, doctors sometimes prescribe a medication such as desmopressin, which reduces the amount of urine produced at night.
Bedwetting can be frustrating and stressful for parents as well as for children; maintaining a loving and supportive attitude is key. As a first option, parents may decide to do nothing about the bedwetting beyond encouraging their child to use the toilet and change their sheets and clothes, since many children naturally outgrow wetting the bed. If the bedwetting doesn’t resolve on its own, they may move on to strategies like using moisture alarms and behavior training. Parents may also consult their child’s doctor to see if they recommend prescription treatment.