Bed-wetting Dr Trisha Macnair Dr Rob Hicks Bed-wetting is regarded as something only small children do, but it's a problem that can affect a surprising number of teenagers and even adults - and one that can be solved.

In this article

What causes it? Who's affected?

What are the symptoms? What's the treatment?

Advice and support

It's not entirely clear why bed-wetting - known as nocturnal enuresis - occurs. Many people used to believe it was a deliberate act to attract attention, but this isn't the case.

Research suggests there's a mismatch between the balance of night-time urine production and the capacity of the bladder to hold it. The problem runs in families and often one or both parents used to wet the bed too.

Other contributory factors can include anxiety, stress, constipation, urinary tract infection and, occasionally, diabetes or kidney failure.

It may be worth visiting your doctor to rule out any treatable causes. Usually there's no specific reason for wetting the bed but underlying conditions should be excluded.

Daytime enuresis, or loss of bladder control during the day, is less common. When this occurs, there's more likely to be a serious underlying problem.

With more than a million people suffering in the UK, it's more common than people think. One in six five-year-olds, one in 11 nine-year olds, and between one in 50 and one in 100 people over the age of 15 (including adults) wet the bed at night.

Boys are more likely to suffer than girls, while men and women are equally likely to wet the bed.

In all children, the development of bladder function control and night-time urine production is a slow process, so most children are affected up to the age of three. In fact, bed-wetting is quite common up to the age of eight. In most cases there's a delay in the development of the normal pathways of bladder function control within the brain and nervous system, which eventually mature.

There aren't really any physical symptoms other than waking up to find the bed is wet. Any other symptoms, such as pain on passing urine, indicate a possible underlying cause, such as infection..

There are, however, psychological symptoms. Wetting the bed makes people feel dirty and ashamed. If it's a child who's affected, the parents often feel it's their fault and that they haven't raised their child well enough. This isn't true.

Family tension is common. Children are punished and parents feel guilty, marriages break up under the pressure of disturbed nights, and there's continual excess laundry.

Although many people eventually grow out of the problem, until they do it's a source of misery. Research shows that people with nocturnal enuresis avoid forming relationships, getting jobs, travelling, and suffer low self-esteem and even depression.

In children, medical treatment is rarely started before the age of six, but there's plenty the family can try at home. Steps you can take include reassuring the child and explaining that it's a common problem, not done consciously and certainly not naughty.

Don't blame the child or punish them, but take practical steps, such as putting a waterproof sheet on the bed. An enuresis alarm can help condition the child into getting up at night to pass urine. These can be purchased from ERIC (see below) or borrowed from a local enuresis clinic. However, one in three children relapse after a few months.

Medical treatments include antidepressants (used for their affect on enuresis not depression) and nasal sprays of antidiuretic hormone, which concentrates urine at night. They don't cure bed-wetting, but provide temporary relief and are best used on a temporary basis for holidays or sleepovers.

There are also lifestyle changes that prove very effective. These include:

• Avoiding caffeinated drinks
• Drinking enough liquid during the day and not just once home from school (many children hardly drink at all during the day then drink lots once they get home)
• Passing urine twice just before bed - go once, then a second time five or ten minutes later

ERIC (Education and Resources for Improving Childhood Continence)

Helpline: 0845 370 8008
Website: www.enuresis.org.uk

This article was last medically reviewed by Dr Rob Hicks in July 2006.