||What causes bedwetting?
Enuresis is a term used for wetting or passing
of urine without control at an age when it would be expected. This
can occur either during the day or night.
Bedwetting (also called Nocturnal Enuresis) is
when a child passes urine when asleep at night. Bedwetting is
normal in children under two years of age. Most children will
develop night-time dryness between two and five years of age, but
some children can still wet the bed at some stage.
If your child reaches the age of 6 years and
is still regularly wetting the bed, this is known as ‘Primary
Enuresis. If your child starts to wet the bed after a period
of being dry (e.g. for 6 months), this is known as ‘Secondary
In either case you should seek advice.
There are several reasons why children may
still wet the bed after the age of five.
- Some children may just be slow developers or are not yet able
to wake themselves up when their bladders are full.
- Children are more likely to wet their bed if they are very
tired and sleeping deeply. Some children, who are normally dry, may
wet their bed when this happens or when unwell.
- Bedwetting is more likely to happen when children drink a lot
before they go to bed. Their bladder may not be able to hold all
the urine that is produced and empty without them waking up.
- For some children, where they have been dry for a period of
time, bedwetting can be a sign of emotional distress. They may be
experiencing anxiety or stress, or it may be a reaction to major
changes in their life (such as when a new baby arrives in the
family or when they start school).
- Bedwetting may also be caused by constipation, urinary tract
infection (UTI) or lack of a hormone called ‘vasopressin’.
- Children are more likely to experience bedwetting if one or
both of their parents had wet the bed as children too.
What are the effects of bedwetting?
What can I do?
Bedwetting may mean that your child misses out
on sleepovers, holidays or trips away. They may feel embarrassed or
ashamed that they still wet the bed. This can affect the child’s
Parents/carers rarely talk about their
children wetting the bed. This may be because people often think
that their child is the only one with a problem. It may also be
because you feel guilty or responsible that you haven’t been able
to do something about the problem.
Is it deliberate or due to
Bedwetting is an ‘involuntary’ loss of urine
at night when a child is sleeping. This means it is an accident and
it is not their fault. You should never blame your child.
Making your child feel bad, ashamed or anxious will only make the
problem harder to deal with.
Below are some things that you can try out
- Make sure your child drinks normally until about an hour before
they go to bed. After this allow small mouthfuls of water to
relieve thirst. Avoid fizzy or caffeine based drinks as these will
stimulate the kidneys and lead to more urine being produced.
- Ensure that going to the toilet is part of your child’s bedtime
routine every night. Encourage them to sit long enough to fully
empty their bladder.
- You may sometimes find it helpful lifting your child from their
bed and sitting them on the toilet. Older children may try waking
themselves up (like setting an alarm).
- Make sure that you praise and encourage your child’s steps
towards dry nights - tell them ‘well done’ for any dry nights -
this often helps.
- Set up a positive reward system for behaviour that is likely to
contribute to night time dryness, without focusing on the actual
bed-wetting. For example, rewards may be given for: drinking
recommended levels of fluid during the day, using the toilet to
pass urine before going to bed/sleep, engaging in management (for
example, taking medication or helping to change sheets).
What if it doesn’t get better?
If bedwetting continues and you don’t see an
increase in dry-nights, you should seek advice from your GP, school
nurse or family health visitor. They will be able to offer you
support and advice, and to refer your child to a specialist like
paediatrician or continence nurse, if they feel this is
If the bedwetting started after your child has
been dry at night for a period of time (secondary enuresis), and
physical problems have been ruled out, your GP or school nurse
might suggest that you see someone from your local child and
adolescent mental health service.
What other treatments are
It is important to note positive rewards for
agreed behaviour (like changing sheets rather than just dry nights)
should to be used along with treatments described below.
Bell and pad
The ‘enuresis alarm’ is a pad that is
connected to an electrical buzzer. When your child starts to wet
the bed, the buzzer goes off. This should wake your child, who then
gets up to go to the toilet. Gradually, your child will recognize
the sensation of a full bladder and learn to wake by themselves
when it is full. It may take your child weeks or months to become
completely dry at night. To be successful your child must be
motivated to become dry at night and fully involved with the
Sometimes children may be prescribed
medication by their GP or specialist clinic. The medications work
by either relaxing the bladder so it can expand and hold more
urine, or help the kidneys produce less urine.
Daytime wetting affects about 1 in 75 children
over the age of five and is more common in girls. The daytime
wetting can occur by itself or when a child is also bedwetting.
This problem can be very stressful or embarrassing for children
when they go to school, as it may lead to teasing or bullying.
What causes it?
A variety of physical or emotional reasons can
cause daytime wetting. In younger children in particular, they may
be so busy playing or doing their work that they simply forget to
use the toilet or leave it too late. They may also be in a hurry
when going to the toilet and do not completely empty their
Some children may be constipated as this can
put pressure on the bladder, or have a urinary tract infection that
needs medical treatment. It can also happen if your child is
anxious or has experienced emotional upset.
What can help?
On a practical basis, encourage your child to
drink around 6-8 glasses of water based drinks throughout the day,
as this helps the bladder to fill properly. It is also important to
encourage healthy eating to avoid any constipation.
Parents can set up a toilet routine, with set
toilet times to discourage ‘holding on’ or forgetting to go to the
toilet. Children may need regular reminders to go to the toilet, or
they can be given a timer or a vibrating wristwatch to remind them
to go to the toilet regularly. To increase a child’s motivation to
go to the toilet regularly, set up a ‘star chart’ with small
rewards for going to the toilet and for dry pants at the end of the
If accidents do happen, try not to get angry,
shout or use punishments. This is likely to add to any shame or
embarrassment that the child may already feel and raise their
anxiety, all of which are likely to make the problem worse.
Speak to your GP or school nurse if
difficulties persist as they can refer you to a specialist if
Soiling (encopresis) occurs when a child does
not reliably use the toilet for a poo/bowel motion. They may dirty
their pants, or go to the toilet in inappropriate places.
Obviously, this is normal in toddlers and
younger children as they learn to control their bowels in the
toilet. However, if it is having a negative effect on family life,
you may wish to seek additional support. Under normal
circumstances, healthy children will develop control over their
bowels by the age of four.
What causes it?
There can be a number of different reasons
that affect a child’s ability to go to the toilet for a poo.
- Not learning a regular toilet routine is a common cause of
soiling. The child may be reluctant to use the toilet. This may
sometimes be part of a general pattern of behaviour, where a child
refuses to do what you want them to.
- Sometimes a change in diet, an infection, taking medication or
life events such as a house move, starting nursery or another
change within the family can trigger constipation.
- Severe constipation causes the bowel to be blocked with hard
poo. The child finds it painful to pass this hard poo, and so
becomes more constipated. Liquid poo then leaks around the
blockage, staining clothes. Children who are constipated may become
irritable, with a lack of energy and a loss of appetite.
- Sometimes a child links pain with pooing. They are fearful and
try to hold in their poo, making it even harder and difficult to
pass. This happens when a child in the past has had hard poo in the
bowel, causing a small split in the anus called a ‘fissure’ that is
If your child is soiling because they have
never had a toileting routine, you can help by encouraging your
child to establish a regular routine by praising them for their
effort and any successes. You can ask for support from your health
visitor or school nurse with this. Star charts and stickers can
prove motivating for children. Ensure that any of your responses
are not punishing.
If you suspect your child is constipated or
their poo is painful to pass, it is a good idea to visit your GP.
Your GP may recommend some helpful medication to help clear your
child’s bowel. Alongside this you can help by making sure that they
eat a lot of fruit, vegetables and foods high in fibre, as well as
exercising and drinking lots of water. This will make the poo
softer and easier to pass. Again, toileting routines, star
charts and non-punishing responses can be helpful.
If your child is not constipated, the cause
may be emotional or psychological. If they start to soil or to
smear faeces after no previous difficulties, they may be
emotionally upset. If you can find out what is upsetting them and
sort it out, the soiling may then improve. If it carries on, your
GP may suggest specialist help from the local child and adolescent
mental health service (CAMHS).
|Case study: 7 year old Emily with
Case study: 6 year old Jack with
Emily developed night time dryness at around
age 4 years. Despite being dry for many years, following the birth
of her baby brother, she regularly wet the bed at night (this is
known as secondary enuresis). Her parents felt very stressed and
angry about this, and viewed this behaviour as being lazy,
attention seeking and defiant. They responded by shouting and
criticising her and enforcing consequences. In response, Emily
tried to cover up her bedclothes being wet and seemed more
withdrawn and quieter than normal.
Physical causes were ruled out. The parents
were told that a setback in normal development when previously dry
was more likely a reaction to psychological (or in some cases
physical) stress i.e. the arrival of a new baby rather than being
caused by laziness, attention seeking or defiance.
The family limited Emily’s intake of fluids
before bedtime, particularly fizzy and caffeinated drinks. She was
encouraged to have a routine regarding going to the toilet before
To help reinforce bladder control, she was
encouraged to change her own nightwear and bedding following
episodes of wetting. Praise and encouragement were given to Emily
by her parents for steps taken towards dry nights. A reward system
was set up for her. She could earn rewards for performing
activities, such as going to the toilet before bedtime each night
and taking responsibility for changing her wet nightwear and
To help Emily adjust to having a new brother,
her parents also spent time with her each day engaged in some
positive activities, such as playing and talking. To help her feel
more involved, she was also given some specific jobs to help with
the care of the baby.
From very young Jack's parents felt he was a
"picky eater" preferring crisps, coke, chips and processed cheese.
Jack became constipated and his poo became dry and hard to pass.
When Jack tried, it was very painful.
Jack became fearful of going to the toilet so
he hung on. His poo became increasingly hard and stuck in bowel,
causing liquid faeces to trickle around the blockage, causing him
to his soil pants. Jack was very ashamed, and hid his pants in many
different places. This caused lots of arguments between him and his
dad. Dad shouted at him to go to the toilet. Jack became reluctant
to co-operate with anything for his parents. He became quite grumpy
Jack's treatment focused on moving the
blocked, dry stools with medication prescribed by his GP. He was
encouraged to drink water and eat healthy foods, with a very simple
Jack's school nurse advised his mum to make
the toilet a rewarding place, by allowing him a special comic or
game he could only use when he was practising pooing. His parents
were also given some information on constipation and soiling.
Jack's dad worked at reducing the conflict
around Jack's toileting routine by reinforcing 'trying to poo',
rather than passing a poo. They praised him for taking medication
and rewarded him with family days out.
Jack’s soiling improved and family felt relieved and positive
about each other.
ERIC (Education and
Resources for Improving Childhood
Offers information and advice about day and
night wetting to parents, young people and professionals.
Dobson, P. (2000) Daytime
Wetting in Childhood – A Helpful Guide for Parents and
Carers. Published by ERIC.
Choices - Has information on day and night
wetting, and soiling problems on their website.
This website gives practical information, tools and activities to
respond helpfully to troubling behaviour and to help children and
young people to flourish.
Revised by the Royal College of Psychiatrists’ Child and Family
Public Education Editorial Board.
Series Editor: Dr Vasu Balaguru
With grateful thanks to Clinical Psychologists Dr Beverley
Dayus, Dr Lindsey Hampson and Emma Ridoch.
This leaflet reflects the best possible evidence at the time of
© Royal College of Psychiatrists March 2017
Due for review March 2020