Nocturnal enuresis: Involuntary urination during sleep

Urination during sleep
Also known as bedwetting, nocturnal enuresis or involuntary urination during sleep is precisely that; or, in other words, an episode of incontinence that occurs during the nighttime when the person is asleep. Bedwetting is more often than not associated with small children, but adults may also be affected. To be clear, we won’t discuss isolated cases such as waking up in a pool of one’s urine (or somebody else’s) after a night of heavy drinking. We are going to focus instead on chronic bedwetting in both children and adults.

Nocturnal enuresis is normal for children under the age of 6-7, although only 15% of children aged 5 years have bedwetting problems, and only 5% of children between the ages of 8 and 11 wet the bed. All children develop nighttime bladder control differently, but a doctor’s involvement may be required if:

  • The child continues wetting the bed after turning 6 or 7.
  • The child begins wetting the bed after a period of nighttime dryness.
  • Painful urination, unusual thirst, pink urine, or snoring accompanies bedwetting.

While the main cause of nocturnal enuresis in children has not been established, several factors are believed to play a part. For example, bedwetting is twice more likely to occur in boys than in girls, especially those with ADHD.

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Causes of bedwetting in children

Small bladder

Inability to recognize  full bladder

Hormone imbalance



Sleep apnea


Chronic constipation

Structural problem

It may not be developed enough to hold urine.

Slow-maturing nerves may not wake the child when bladder is full.

Low production of anti-diuretic hormone (ADH).

A new sibling, starting a new school, moving, etc.

Urinary tract infection can hinder urination control.

Caused by inflamed tonsils or adenosis.

Bedwetting in a usually dry-at-night child may be the first symptom of diabetes.

Can lead to bladder not being able to contain much urine.

Bedwetting is seldom related to a neurological system or urinary system defect.


A smaller bladder, decreased levels of AHD, and conditions like diabetes, urinary tract infection, and neurological disorders have been linked to adult bedwetting as well. Additionally, some studies have suggested the possibility that nocturnal enuresis is hereditary. People who have one parent who wet the bed have a 40% chance of developing involuntary urination, while people whose two parents wet the bed have an 60% chance of wetting the bed themselves.

Note: it is important to clarify that ‘small bladder’ does not refer to the size of the organ but to its volume capacity. That is, a small bladder is able to hold only a small amount of urine before its nerves send signals to the brain that it is time to empty it.

 Children need to be examined by a doctor who may perform urine tests, X-rays, or imaging tests, depending on the circumstances. As for adults, they can help the physician establish a diagnosis by monitoring their own urinary patterns for at least two days before a visit to the doctor, including:

  • Voiding times during the day and night.
  • Time of day or night that accidents take place.
  • Quantity of urine voided.
  • Drinking patterns (quantity, timing, and type of fluids).
  • Urinary stream nature.
  • Existing recurring UTI’s.
  • Number of wet nights compared to number of dry nights.

Adults who suffer from nocturnal enuresis can modify their fluid intake habits in order to decrease their need for emptying their bladder at night. For instance, they can drink as much liquid as they can during the daytime and then refraining from voiding for 2 to 3 hours in order to increase their functional bladder capacity. Conversely, they can limit their fluid intake in the late afternoon and evening to produce less urine during the night. That doesn’t mean drinking less fluid –especially water- but shifting the time of fluid intake. Parents can limit fluid intake –particularly caffeine- during the evening, encourage double voiding before putting children to bed, as well as regular use of toilet during the day, and treat constipation.

Both adults and children can benefit from bedwetting alarms and medications such as:





Slows nighttime urine production and increase ADH production.

Calm small bladders.

Changes sleeping and waking patterns.

Whether it is behavioral therapies or medication, treatment for involuntary urination during the night should be prescribed and supervised by a licensed physician.