Bed wetting, is the involuntary voiding of urine during sleep, with a severity of at least 3 times a week in children over the age of 5. A mentally handicapped child is generally expected to become dry at night when he or she reaches the mental age of four. It is estimated that more than 5 million children in the US experience nocturnal enuresis.

One of the most difficult aspects of bed wetting is its effect on children and their families. The greatest impact is on the child’s self-esteem. Bedwetting is often a source of great embarrassment for the child causing him or her to refrain from certain age-appropriate activities such as a sleep-over for fear of a bedwetting accident. Bed wetting can have an effect on school performance and later sexual activity as a result of the low self-esteem bedwetting can cause. Often parents become frustrated with continued bedwetting as it is a drain of time, energy, and money with constant cleaning and bed changing. Sometimes bedwetting can be a source of embarrassment for the parents who may view the problem as a result of bad parenting or a mischievous child, neither of which are true. It is crucial to remember that bedwetting happens to MILLIONS of children and that bed wetting is not the fault of the child or the parent.

Ages 1-2: The child has a conscious sensation of the bladder filling with urine.

Ages 2-3: The ability to urinate or to voluntarily stop urinating develops and children begin to learn the etiquette surrounding urination.

Ages 3-4: Most children by the age of the 4 have achieved urinary control and are dry both day and night.

Causes

Many causes of nocturnal enuresis (bed wetting) exist. Bedwetting is not a result of laziness or disobedience on the behalf of the child. Bedwetting is caused by many factors.

Bedwetting has been found to be genetically linked. One study has shown that a child of two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 44% chance of becoming a bedwetter. While little scientific support exists, many hold the “deep-sleep” theory which blames the exceptionally deep sleep some children experience as the cause of wetting the bed. Because a child is so deep in sleep, his brain and body ignore the signals of a full bladder.

Another cause cited for primary bed wetting is a “smaller” bladder. This does not mean, however, that the physical size of the bladder is smaller for bedwetting children than for their peers. Instead it means that their Functional Bladder Capacity (FBC) -the amount of urine the bladder will hold until sending a signal to the brain indicating it is time to urinate- is a smaller volume than that of their peers.

Another cause of bedwetting has to do with ADH or anti-diuretic hormone. ADH is a signaling hormone which tells the kidney to decrease the amount of urine produced. Normally the body produces more ADH at night causing the kidneys to produce less urine. Decreased urine production at night allows an individual to sleep through the night without having to urinate. Some people do not produce more of this hormone at night, as they are supposed to, and therefore produce a large amount of urine at night. In similar cases, the body produces ADH but the kidneys do not respond and continue to produce the same amount of urine.