There are three main physiological causes of nighttime bedwetting: deep sleep, excessive nighttime urine production, and insufficient bladder functional capacity/overactive bladder. There is also a genetic predisposition. The likelihood increases to 80% in children where both parents had prolonged bedwetting issues. Although bedwetting is sometimes still perceived as psychological in society, this accounts for no more than 5% of cases. Other possible causes include urinary tract infections, diabetes mellitus, certain anatomical abnormalities, obesity, and sleep apnea.

Studies examining the sleep of children with nocturnal enuresis have shown their sleep quality is impaired compared to peers without bedwetting. Research has found a close relationship between bedwetting and the development of sleep apnea (airway obstruction). Contrary to popular belief, children who wet the bed actually experience disrupted sleep quality due to breathing problems. Many parents believe their children wet the bed because they sleep too deeply, but the main problem is actually a communication issue between the bladder and brain during sleep.

If a child has persistent snoring, sleep apnea, excessive night sweating, or mouth breathing during sleep, after detailed urological investigation by a pediatric urologist, evaluation by an ENT specialist may be requested. Additionally, obesity (excessive weight) and/or allergic conditions in children may also be associated with bedwetting. In such cases, after thorough investigation by a pediatric urologist, multidisciplinary treatment planning with relevant specialists is valuable for managing the condition.

While over 95% of bedwetting causes are considered organic, about 5% of cases may have psychological origins. If a child develops bedwetting after being completely dry for 6 months or more following toilet training, psychological or behavioral causes should be investigated. Otherwise, if a child has never achieved nighttime dryness since toilet training, urological causes should be considered. Therefore, determining when the bedwetting problem began is important.

For psychologically-related bedwetting, family changes (e.g., divorce, relocation, new sibling, death), school stress, peer relationship problems, and similar anxiety-inducing situations should be examined. Additionally, traumatic events (sexual/physical trauma), violence, or bullying may also cause bedwetting. Scientific studies report that children diagnosed with ADHD may experience more severe bedwetting that is sometimes more resistant to treatment. In such cases, psychological support therapies should be added alongside pediatric urology treatment for faster and safer management.

Although most children (90%) don't have psychological causes, untreated bedwetting can lead to psychological effects. Bedwetting can make children feel insecure, withdrawn, socially isolated, reluctant to sleepovers, and cause sleep deprivation from frequent nighttime waking - leading to tiredness, irritability, and negative impacts on academic performance. Over time, children may develop both urological and mental health difficulties. Therefore, early treatment intervention is extremely valuable to prevent more complex and prolonged treatment processes.

Bedwetting has a hereditary component. If neither parents nor close relatives had bedwetting issues, a child's likelihood is 15%. If one parent or close relative had the problem, the probability increases to 44%, and if both parents had similar histories, it may rise to 77%. However genetically, bedwetting is a complex urological condition with multiple contributing factors. Therefore, thoughts like "His uncle also wet the bed, his aunt did until age 10, it's genetic in our family, it'll resolve on its own, nothing we do can change genetics" are misguided, and support should be sought from pediatric urology departments for this treatable condition.

Bedwetting is relatively common in children, affecting 5-10% of 7-year-olds, while prevalence drops to 1-2% in adolescents. Scientific studies show 0.5-1% of adults continue to wet the bed.

While occurrence differs by gender, it's twice as common in boys as in girls.

While bedwetting shows a spontaneous annual resolution rate of 15%, the likelihood of self-resolution without treatment remains low. Research indicates 7 out of 100 children who wet the bed at age seven will continue into adulthood. Additionally, untreated children may have higher potential for developing different urological problems later in life compared to healthy peers, even if bedwitting resolves.

Without treatment, there's no way to predict when bedwetting might end - it may persist through adolescence or even adulthood. Therefore, leaving untreated or delaying treatment for a condition that negatively affects children's psychological and academic development would be an incorrect approach.

According to the latest guidelines from the International Children's Continence Society and European Association of Urology, children over 5 years old who wet the bed enough to soak their bedding more than twice a month should be evaluated and treated by pediatric urology departments. If your child is under 5, they may not have fully developed physiological and neurological nighttime bladder control. However, since bedwetting could indicate underlying conditions, medical evaluation is still essential. Raising parental awareness for early diagnosis is crucial.

The treatment of nighttime urinary incontinence can vary depending on accompanying symptoms, underlying causes, and the severity and volume of leakage. It is crucial to tailor each child’s treatment plan to their individual needs and family dynamics to ensure a successful outcome. Before initiating any treatment, the condition should be clearly explained to the child, parents, and caregivers. Parents should be encouraged to seek medical help and educated about the negative impact of bedwetting on both the child’s and the family’s quality of life. Maintaining the motivation of both the child and the family throughout the process is essential.

• Urotherapy Education (Healthy Bladder & Bowel Training): A program led by specialist physiotherapists targeting behavior change in the child and family. It covers proper toileting posture, healthy eating and drinking habits, age-appropriate fluid intake, bladder and bowel emptying techniques, timed voiding schedules, and related routines. It also emphasizes limiting excessive fluid intake before bedtime and spreading fluid consumption appropriately throughout the day. Scientific studies have shown that reducing electronic device use before bed improves sleep quality in children. Content is customized to each child’s symptoms and needs.
• Bedwetting Alarm Therapy: Uses a device that emits sound and vibration upon detecting wetness. The goal is to train the child to wake up, with or without caregiver assistance, in response to the alarm. Over time, the child becomes aware of bladder fullness, enabling them to hold urine or wake up to void. Studies report better improvement and lower relapse rates in children using alarm therapy compared to untreated children. Recommended duration varies (8–12 weeks per the International Children’s Continence Society, up to 16–20 weeks). The child’s active participation and understanding of the therapy are crucial for success.
• Medication Therapy: Medications should be prescribed by the appropriate specialist based on the type, severity, and volume of leakage. Antidiuretic medications are commonly used to reduce nighttime urine production. If the child exhibits overactive bladder symptoms at night, anticholinergic medications may be combined to reduce bladder contractions.
• Pelvic Floor Muscle Rehabilitation: Performed by specialist physiotherapists, this method retrains the pelvic floor muscles responsible for urine retention and voiding. Techniques include massage, diaphragmatic breathing, biofeedback-assisted exercises, stabilization exercises, and neuromodulation. These exercises improve the child’s ability to control bladder contractions and enhance continence.
• Complementary Therapies: High-quality scientific studies have shown that hypnotherapy, psychotherapy, acupuncture, chiropractic, and herbal treatments do not provide effective benefits in the treatment of nocturnal enuresis.

When planning treatment for a child who wets the bed, one or more of the above options may be included based on the child’s specific symptoms. Ensuring the child’s and family’s engagement and adherence to the recommended plan is of utmost importance.

Untreated or unaddressed nighttime urinary incontinence—even if considered “normal” or expected to resolve on its own—can eventually affect the child’s psychological well-being. It may lead to loss of self-confidence, reduced self-esteem, social isolation, withdrawal, anger, anxiety, sadness, and other emotional difficulties, making the problem more complex and harder to resolve.

Having caregivers wake the child overnight to prevent bedwetting can disrupt the child’s sleep and does not address the underlying issue. Therefore, these patients require evaluation and treatment by specialist physicians.

First, the cause and severity of nighttime bedwetting should be assessed by the relevant physician. A detailed medical history and physical examination by a pediatric urology specialist are extremely valuable. During history-taking, information on past medical history (medications, surgeries, related health conditions, etc.), voiding and bowel habits, dietary habits, toilet training, accompanying sleep-related breathing problems, and psychological issues should be explored thoroughly. In the physical examination, genital anatomical structures and the lumbar region containing the nerve pathways that control the bladder should be examined, and MRI may be requested if deemed necessary.

• Urinalysis and urine culture: Ordered if a urinary tract infection is suspected.
• Blood tests: For evaluation of infections, investigation of metabolic disorders, assessment of hormonal imbalances, and kidney function.
• Renal and bladder ultrasound: A simple, practical imaging technique that provides information about kidney dilation (hydronephrosis) and anatomical anomalies (e.g., cysts). It also measures post-void residual urine, bladder wall thickness, and can detect stool masses in the rectum suggestive of constipation.
• Voiding test (uroflowmetry): A painless, non-invasive test performed on a sensor-equipped toilet that measures urine flow. Children often find it enjoyable.
• Bladder diary (2-day voiding diary): Records daily voids and urine volumes, any daytime leaks, and fluid intake. Parents may assist younger children. Access DryKids®’ 2-day bladder diary via the provided link.
• Bowel diary (7-day stool diary): Records stool timing and consistency for one week when constipation is suspected. Note any incontinence episodes daily. Access DryKids®’ 7-day stool diary via the provided link.
• Bedwetting chart (30-day enuresis diary): Tracks dry and wet nights to monitor bedwetting frequency and severity, including alarm activation time, bedtime, wake time, and urine volume during alarm therapy. Use sun and cloud icons for engagement. Access DryKids®’ bedwetting chart via the provided link.

Pediatric urology specialists will select the appropriate tests based on the child’s age, symptoms, and clinical findings, and use the results to plan the best treatment approach.