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Bedwetting and Nocturnal Enuresis
Other factors might include a urine infection (if you experience pain on having a wee contact your doctor). Being tired or worried can also have an effect and trigger episodes of bedwetting.
Note about sleep. Sleep consists of two main important phases 1) Non-Rapid Eye Movement (NREM) and 2) Rapid Eye Movement (REM). These phases alternate in cycles about every 90-100 minutes. NREM sleep is broken down into 4 stages of progressively deeper sleep, and stage 4 forms 50% of all our sleep; this stage is important for the physical rejuvenation of the body. REM sleep is a different phase of sleep where dreaming occurs.
What can I do to help myself?
Although the causes of bedwetting are out of your control, there are some things you can do to help manage the situation. Taking a positive approach can be the first step on the road to becoming dry.
It is impossible to predict when you will become dry, as everyone's circumstances and bodies are different. However, it is important to stay positive and remember that most teenagers do, quite naturally, become dry without any help. At least 1 in 6 children and teenagers stop wetting the bed every year!
If you are lucky, you may become dry without any assistance, but with professional help, you are more likely to become dry sooner. If you have not already done so, do pluck up the courage to confide in a parent, doctor or local specialist advisor, even if you have tried to get help in the past and it has not worked. You may be worried about the first visit, but your advisor will have seen lots of teenagers like yourself. Remember there are many young people in the same boat - so take heart.
Who can help me?
The good news is that there are many people trained in this area, but your first contact is likely to be with your doctor or school nurse. They will probably ask you questions about your bladder and you are likely to be asked for a urine sample to check for an infection. If it appears that you have a history of urinary infections, or urgency (a sudden need to wee, without much warning) your doctor may recommend that you have further tests.
Try not to be embarrassed about your bedwetting; your health professional will have seen many people in the same situation. Before you visit them you might find it useful to write down your questions in a notebook and take this with you. This will mean you have something to refer to and a place to write down any useful information they give you.
Your doctor may also be able to let you know if there is a specialist bedwetting clinic or nurse in your area. If they do not have this information, please contact ERIC and we will try to find one for you.
What treatment is available?
An enuresis alarm or buzzer
An enuresis alarm consists of a sensor and a noise box. The sensor detects when you start to wee. This causes the noise box or alarm to sound and this is designed to wake you up. At the same time as the alarm goes off, your pelvic floor muscles will contract and you should stop weeing and be able to get up and go to the toilet. Gradually, you can learn to wake up and "hold on" to the sensation of a full bladder without the alarm. For more information on the pelvic floor, please download the pelvic floor leaflet
Alarms are perfectly safe to use, but it is important to realise that they do not work for everyone.
If you are interested, you may be able to borrow an alarm free from your school nurse, continence nurse, GP or hospital, or you can ask your parent or carer to buy one (they cost between £50-100 and are available from ERIC). There are two types of alarms, the "mini" (personally) worn alarm or the bedside model.
If you decide to use an alarm you need to allow about 4-12 weeks to see signs of progress. It is also important to understand that progress may be gradual rather than dramatic. The idea is to watch out for small signs of improvement, an example of which might be that when you wake to your alarm your bed is less wet and you wee more in the toilet. To be successful, you will need to be patient. But with the support of a parent or advisor, it can be a very useful form of treatment, with approximately a 70% success rate.
Do still try an enuresis alarm, even if you were unsuccessful when you were younger. There are many reasons why they can work when you are a bit older, such as the natural improvement of your bladder control. If you have tried the alarm without success before, please read the section I have already tried the alarm but it did not work.
Medication
Medicines can often help with bedwetting, but they do not work for everyone and they rarely provide a cure. They must be prescribed by a doctor. (In some cases nurses can also prescribe).
The most common medication is called desmopressin. It is taken at bedtime and reduces the activity of the kidneys, so that they produce less urine. It can be taken as a tablet or a nasal spray. Its effects last for 5-9 hours and it should work from the first night it is taken.
This medication might help if you are producing too much urine at night. If you wet the bed it could be that your urine production does not slow down at night. (Generally, we make more urine during the day than at night). If you are wet, you may not be producing enough vasopressin, a hormone that reduces urine production. Not producing enough vasopressin causes the kidneys to produce more urine than your bladder can hold. Desmopressin is a chemical form of vasopressin and can correct the imbalance.
Desmopressin is a commonly prescribed medication and side effects are rare, however it is very important to follow your doctor's advice. It is also important to restrict fluid intake for a few hours before medication is taken and not to drink after taking it. Fluid intake can, in some cases, lead to a serious but rare condition called Hyponatraemia. This is where excessive fluid leads to a build-up of water, which dilutes the salt in the body; this can lead to convulsions. If you have any questions, please consult with your doctor.
Oxybutinin is a medication that is sometimes prescribed for young people who have daytime ‘urgency', or a sudden, urgent need to go to the toilet. Some young people only have this problem at night, so it may be a factor in bedwetting. The medication works by helping the bladder muscle to relax so that it can hold more urine. for more information please refer to our section on Daytime Wetting
Combination of Oxybutinin and Desmopressin These two medications can often be combined successfully if the single drugs don't do the trick.
There are some other medications that your doctor may prescribe. If you have any questions, please ask them what the medication is and how it will work on your body.
What should I eat and drink?
This is a question we are asked by many young people but unfortunately, there are not many straight answers. One thing we do know is that it is important to drink well throughout the day, at least 6-8 glasses. Water or a well-diluted squash or fruit drink is best.
There has been some research into the types of food and drink that might trigger bedwetting.
Tea, coffee and fizzy drinks can stimulate the kidneys to produce more urine, so can cause a problem at night. Milk drunk just before bedtime can also affect some people. Some drinks, which seem to be particularly associated with increased urine output, are citrus drinks such as orange and blackcurrant.
Alcohol is a ‘diuretic'- this means it causes more urine to be produced; this can make bedwetting worse. (If you think this is affecting your bedwetting, it might be best to cut down or avoid alcohol altogether, just for a while to see if this makes a difference).
Why not try being an ‘amateur scientist' and experiment by leaving out one type of drink e.g. coffee or a fizzy drink and see if there is any improvement? If there isn't, you can put it back and try something else. This might be something you would like to record in your diary.
In terms of food, try to avoid getting constipated, as this may affect the bladder. A diet with plenty of fresh fruit and vegetables, cereals with lots of fibre and brown bread might help. If you think that you might be constipated, you should try to get this sorted out first; speak to a trusted adult, doctor or nurse. The bad news is that for some people chocolate in all its forms may also stimulate urine production! But don't panic -just try experimenting to find out if it is a trigger for you. If you are worried that you might be constipated, please refer to our section on constipation and soiling.
I have already tried an alarm but it did not work - what is wrong?
It can be disappointing if the enuresis alarm does not work first time, but difficulties like this are not unusual and there are several ways to help overcome them.
Did everyone else in the family except you wake up when the alarm went off? If so, do try to be positive about the alarm and believe in your ability to hear it. Before you go to sleep, tell yourself you will hear it and wake up. You might recall a time when you did manage to wake early, such as before a holiday, or when it was important to get an early start. You may also want to consider a different alarm, there are even ones now where you can record your own message!
Even if you are not waking, as long as someone is hearing the alarm and waking you up, this is also a positive step. Check to see if your "wet patch" is getting smaller. If it is, then you are successfully "holding on", which is the first step to becoming dry.
Remember - don't lose heart and do be positive about the alarm. There is a very good chance that the alarm will work for you on the second or third time, even if there has been a gap of a year or so. There are many reasons why they can be successful when you are a bit older, such as the natural improvement of your bladder control.
False alarms are common and can be caused by perspiration. If this happens to you, check that your sheets are mainly cotton, not nylon, and use less bedding - try a sheet plus a blanket rather than a duvet. Also try using a single waterproof sheet on the mattress, rather than a fully fitted mattress protector. Do make sure that your sheets are washed after a wet bed. This is because urine, together with perspiration, could trigger the alarm.
Can complementary therapies help me?
You may have heard that some complementary therapies such as homeopathy and hypnosis are useful in treating bedwetting and you might want to try one. These therapies do help some people, but there has been very little research to prove how helpful they really are. It is worth noting that if you are interested in complementary therapies, you will probably have to pay for them yourself. For further information please download our Complementary Therapies Leaflet
I am starting college soon, how can I manage?
Leaving home for the first time can be a daunting experience, but do not let your bedwetting deter you. When you visit the college on the open day, take the opportunity to check out the laundry facilities and the type of rooms available. Many colleges these days have en suite rooms. If you have a question, you can also have a chat with the college health unit or hall of residence manager. There are also ways you can discreetly protect your bed using bedding protection, such as bedpads and waterproof sheets. These products are available to buy from ERIC. Remember - work hard but have fun!
Can I go on sleepovers or away on holiday?
The possibility of a trip away from home is often exciting, but for people who experience bedwetting, it can also be a time of mixed emotions. Many young people would like to go on trips or sleepovers but are worried that their friends and other people might find out that they wet the bed. This can often lead to them missing out on opportunities to mix and have fun with other teenagers. If you have a trip or overnight stay coming up, you may find the following tips useful. Stay positive! Being relaxed and having fun is good for you!
Should I tell my girlfriend/boyfriend?
This can be a very sensitive issue but, if your relationship is close, and trusting, it is often helpful to say that you might wet the bed. If you don't, it could make you feel more tense and anxious and might put a barrier between you. You will probably find that your partner is very sympathetic and will support your efforts to become dry at night. You might prefer to use the medication desmopressin, if it works for you, to help you feel more confident if you start sleeping with your partner.
How many young people wet the bed?
There are many young people who wet the bed but it is not something everyone wants to talk about. We think that there are about half a million young people with this problem in the UK, this means about 1 in 30-40. It also affected many sports people and celebrities in their youth, such as the footballer Paolo DiCanio and actor Martin Clunes.
What are the causes?
Although bedwetting is a very common condition, the causes are still not fully understood. One thing we do know is that bedwetting is not due to laziness or a lack of willpower. So there is nothing to be ashamed of. Research has recently helped us find a ‘bedwetting gene' which means that it can often run in families.
Nocturnal enuresis (the medical term for bedwetting) happens when the bladder is full and the signal to wake up and to ‘hold on' doesn't get through to the brain. There are a number of possible causes for this, some of which might apply to you.
- Your urine production may not slow down at night. (Generally we make more urine during the day than at night). If you are wet, you may not be producing enough vasopressin, a hormone that reduces urine production. Not producing enough vasopressin causes the kidneys to produce more urine than your bladder can hold.
- You might have a small bladder which means you can store less urine than average or you might have an ‘overactive' bladder. The bladder is made of muscle and is like a ‘stretchy bag' which stores the urine produced by your kidneys. When the bladder is ‘overactive' it may suddenly contract during the filling stage. This can result in the bladder needing to empty before it reaches full capacity. Symptoms of an ‘overactive' bladder are a sudden and urgent ‘need to wee' during the day.
Other factors might include a urine infection (if you experience pain on having a wee contact your doctor). Being tired or worried can also have an effect and trigger episodes of bedwetting.
Note about sleep. Sleep consists of two main important phases 1) Non-Rapid Eye Movement (NREM) and 2) Rapid Eye Movement (REM). These phases alternate in cycles about every 90-100 minutes. NREM sleep is broken down into 4 stages of progressively deeper sleep, and stage 4 forms 50% of all our sleep; this stage is important for the physical rejuvenation of the body. REM sleep is a different phase of sleep where dreaming occurs.
What can I do to help myself?
Although the causes of bedwetting are out of your control, there are some things you can do to help manage the situation. Taking a positive approach can be the first step on the road to becoming dry.
- If you have not already done so, why not visit your doctor, school nurse or local continence advisor (a specialist nurse)? All these people are trained professionals and are there to help you. Try not to be embarrassed about your bedwetting; they will have seen many people in the same situation. Before you visit a health professional, you might find it useful to write down your questions in a notebook and take this with you. This will mean you have something to refer to and a place to write down any useful information they give you.
- Why not keep a diary or chart of your wetting pattern? In this diary you could also record other possible factors, such as the food you have eaten, number and type of drinks you have had or any particular concerns, such as exams, relationships or periods of illness. This might help you spot any potential ‘triggers'.
- Be kind to yourself! Try to relax and do not blame yourself for your bedwetting. Remember it's not your fault! Treat yourself to a warm soothing bath before bed and read a good book or listen to some relaxing music before falling gently to sleep.
- Some people find it helpful to set an alarm clock to go off a couple of hours after going to bed. When the alarm sounds they get up and go the toilet. This can be repeated 1-2 hours before your usual waking time. If you do this, try to vary the times you set the alarm, this will avoid your bladder getting into the habit of emptying at the same time.
- We find that many young people who contact us do not drink enough throughout the day; so it might also help to try to drink more fluids, especially water or water-based drinks. Drinking more will help increase bladder capacity, or the amount the bladder will hold before feeling "full". The recommendation is 6-8 drinks spread throughout the day. For more information on what type of fluids are best refer to the section on What should I eat and drink?
- Watching television or playing exciting computer games in your bed before you go to sleep may trigger bedwetting incidents. Try to turn the television off at least half an hour before you go to sleep and instead read quietly or listen to some relaxing music. If you have worrying things on your mind, you might want to talk to a trusted friend or adult; it can often be better to get things off your chest. Try not to take worries to bed with you. Remember to think positively and remind yourself that at least 1 in 6 children and teenagers stop wetting the bed every year!
It is impossible to predict when you will become dry, as everyone's circumstances and bodies are different. However, it is important to stay positive and remember that most teenagers do, quite naturally, become dry without any help. At least 1 in 6 children and teenagers stop wetting the bed every year!
If you are lucky, you may become dry without any assistance, but with professional help, you are more likely to become dry sooner. If you have not already done so, do pluck up the courage to confide in a parent, doctor or local specialist advisor, even if you have tried to get help in the past and it has not worked. You may be worried about the first visit, but your advisor will have seen lots of teenagers like yourself. Remember there are many young people in the same boat - so take heart.
Who can help me?
The good news is that there are many people trained in this area, but your first contact is likely to be with your doctor or school nurse. They will probably ask you questions about your bladder and you are likely to be asked for a urine sample to check for an infection. If it appears that you have a history of urinary infections, or urgency (a sudden need to wee, without much warning) your doctor may recommend that you have further tests.
Try not to be embarrassed about your bedwetting; your health professional will have seen many people in the same situation. Before you visit them you might find it useful to write down your questions in a notebook and take this with you. This will mean you have something to refer to and a place to write down any useful information they give you.
Your doctor may also be able to let you know if there is a specialist bedwetting clinic or nurse in your area. If they do not have this information, please contact ERIC and we will try to find one for you.
What treatment is available?
An enuresis alarm or buzzer
An enuresis alarm consists of a sensor and a noise box. The sensor detects when you start to wee. This causes the noise box or alarm to sound and this is designed to wake you up. At the same time as the alarm goes off, your pelvic floor muscles will contract and you should stop weeing and be able to get up and go to the toilet. Gradually, you can learn to wake up and "hold on" to the sensation of a full bladder without the alarm. For more information on the pelvic floor, please download the pelvic floor leaflet
Alarms are perfectly safe to use, but it is important to realise that they do not work for everyone.
If you are interested, you may be able to borrow an alarm free from your school nurse, continence nurse, GP or hospital, or you can ask your parent or carer to buy one (they cost between £50-100 and are available from ERIC). There are two types of alarms, the "mini" (personally) worn alarm or the bedside model.
If you decide to use an alarm you need to allow about 4-12 weeks to see signs of progress. It is also important to understand that progress may be gradual rather than dramatic. The idea is to watch out for small signs of improvement, an example of which might be that when you wake to your alarm your bed is less wet and you wee more in the toilet. To be successful, you will need to be patient. But with the support of a parent or advisor, it can be a very useful form of treatment, with approximately a 70% success rate.
Do still try an enuresis alarm, even if you were unsuccessful when you were younger. There are many reasons why they can work when you are a bit older, such as the natural improvement of your bladder control. If you have tried the alarm without success before, please read the section I have already tried the alarm but it did not work.
Medication
Medicines can often help with bedwetting, but they do not work for everyone and they rarely provide a cure. They must be prescribed by a doctor. (In some cases nurses can also prescribe).
The most common medication is called desmopressin. It is taken at bedtime and reduces the activity of the kidneys, so that they produce less urine. It can be taken as a tablet or a nasal spray. Its effects last for 5-9 hours and it should work from the first night it is taken.
This medication might help if you are producing too much urine at night. If you wet the bed it could be that your urine production does not slow down at night. (Generally, we make more urine during the day than at night). If you are wet, you may not be producing enough vasopressin, a hormone that reduces urine production. Not producing enough vasopressin causes the kidneys to produce more urine than your bladder can hold. Desmopressin is a chemical form of vasopressin and can correct the imbalance.
Desmopressin is a commonly prescribed medication and side effects are rare, however it is very important to follow your doctor's advice. It is also important to restrict fluid intake for a few hours before medication is taken and not to drink after taking it. Fluid intake can, in some cases, lead to a serious but rare condition called Hyponatraemia. This is where excessive fluid leads to a build-up of water, which dilutes the salt in the body; this can lead to convulsions. If you have any questions, please consult with your doctor.
Oxybutinin is a medication that is sometimes prescribed for young people who have daytime ‘urgency', or a sudden, urgent need to go to the toilet. Some young people only have this problem at night, so it may be a factor in bedwetting. The medication works by helping the bladder muscle to relax so that it can hold more urine. for more information please refer to our section on Daytime Wetting
Combination of Oxybutinin and Desmopressin These two medications can often be combined successfully if the single drugs don't do the trick.
There are some other medications that your doctor may prescribe. If you have any questions, please ask them what the medication is and how it will work on your body.
What should I eat and drink?
This is a question we are asked by many young people but unfortunately, there are not many straight answers. One thing we do know is that it is important to drink well throughout the day, at least 6-8 glasses. Water or a well-diluted squash or fruit drink is best.
There has been some research into the types of food and drink that might trigger bedwetting.
Tea, coffee and fizzy drinks can stimulate the kidneys to produce more urine, so can cause a problem at night. Milk drunk just before bedtime can also affect some people. Some drinks, which seem to be particularly associated with increased urine output, are citrus drinks such as orange and blackcurrant.
Alcohol is a ‘diuretic'- this means it causes more urine to be produced; this can make bedwetting worse. (If you think this is affecting your bedwetting, it might be best to cut down or avoid alcohol altogether, just for a while to see if this makes a difference).
Why not try being an ‘amateur scientist' and experiment by leaving out one type of drink e.g. coffee or a fizzy drink and see if there is any improvement? If there isn't, you can put it back and try something else. This might be something you would like to record in your diary.
In terms of food, try to avoid getting constipated, as this may affect the bladder. A diet with plenty of fresh fruit and vegetables, cereals with lots of fibre and brown bread might help. If you think that you might be constipated, you should try to get this sorted out first; speak to a trusted adult, doctor or nurse. The bad news is that for some people chocolate in all its forms may also stimulate urine production! But don't panic -just try experimenting to find out if it is a trigger for you. If you are worried that you might be constipated, please refer to our section on constipation and soiling.
I have already tried an alarm but it did not work - what is wrong?
It can be disappointing if the enuresis alarm does not work first time, but difficulties like this are not unusual and there are several ways to help overcome them.
Did everyone else in the family except you wake up when the alarm went off? If so, do try to be positive about the alarm and believe in your ability to hear it. Before you go to sleep, tell yourself you will hear it and wake up. You might recall a time when you did manage to wake early, such as before a holiday, or when it was important to get an early start. You may also want to consider a different alarm, there are even ones now where you can record your own message!
Even if you are not waking, as long as someone is hearing the alarm and waking you up, this is also a positive step. Check to see if your "wet patch" is getting smaller. If it is, then you are successfully "holding on", which is the first step to becoming dry.
Remember - don't lose heart and do be positive about the alarm. There is a very good chance that the alarm will work for you on the second or third time, even if there has been a gap of a year or so. There are many reasons why they can be successful when you are a bit older, such as the natural improvement of your bladder control.
False alarms are common and can be caused by perspiration. If this happens to you, check that your sheets are mainly cotton, not nylon, and use less bedding - try a sheet plus a blanket rather than a duvet. Also try using a single waterproof sheet on the mattress, rather than a fully fitted mattress protector. Do make sure that your sheets are washed after a wet bed. This is because urine, together with perspiration, could trigger the alarm.
Can complementary therapies help me?
You may have heard that some complementary therapies such as homeopathy and hypnosis are useful in treating bedwetting and you might want to try one. These therapies do help some people, but there has been very little research to prove how helpful they really are. It is worth noting that if you are interested in complementary therapies, you will probably have to pay for them yourself. For further information please download our Complementary Therapies Leaflet
I am starting college soon, how can I manage?
Leaving home for the first time can be a daunting experience, but do not let your bedwetting deter you. When you visit the college on the open day, take the opportunity to check out the laundry facilities and the type of rooms available. Many colleges these days have en suite rooms. If you have a question, you can also have a chat with the college health unit or hall of residence manager. There are also ways you can discreetly protect your bed using bedding protection, such as bedpads and waterproof sheets. These products are available to buy from ERIC. Remember - work hard but have fun!
Can I go on sleepovers or away on holiday?
The possibility of a trip away from home is often exciting, but for people who experience bedwetting, it can also be a time of mixed emotions. Many young people would like to go on trips or sleepovers but are worried that their friends and other people might find out that they wet the bed. This can often lead to them missing out on opportunities to mix and have fun with other teenagers. If you have a trip or overnight stay coming up, you may find the following tips useful. Stay positive! Being relaxed and having fun is good for you!
- If you have not already done so, see if the medication desmopressin works for you. This is a nasal spray or tablet that causes the kidneys to produce a smaller amount of urine. If you wet the bed, your urine production might not slow down at night. (Generally, we make more urine during the day than at night). If you are wet, you may not produce enough vasopressin, a hormone that reduces urine production. Not producing enough vasopressin causes the kidneys to produce more urine than your bladder can hold. Desmopressin is taken just before bedtime and will have an immediate effect if it is going to work. It can be taken long-term by teenagers providing you have a medical review every three months. The review will identify if you are producing enough vasopressin to stop the bedwetting. Desmopressin is a commonly prescribed medication and side effects are rare, however it is very important to follow your doctor's advice. It is also important to restrict fluid intake for a few hours before medication is taken and not to drink after taking it. Fluid intake can, in some cases, lead to a serious but rare condition called Hyponatraemia. This is where excessive fluid leads to a build-up of water, which dilutes the salt in the body; this can lead to convulsions. If you have any questions, please consult your doctor.
- If you have had some success with the enuresis alarm and do not have problems waking at night, the alarm might be an option. You could try setting your body-worn alarm to ‘vibration' only and this might wake you, without waking anyone else. In addition, there are now alarms available where you can record your own message. You could set it to make the sound of a mobile phone (possibly receiving a text message); this would not be an unusual sound and easily explained if anyone asked. (These alarms can be purchased from ERIC.) If you think that you would like to try this strategy, it would be wise to practice at home before you go away.
- You might consider purchasing a washable sleeping bag protector. These are waterproof liners, which slip inside a normal sleeping bag. They are available to buy from ERIC.
- Many people keep their bedwetting a secret but some young people do find it helpful to confide in a trusted friend or adult - this can make it easier to talk about overnight stays.
- Be careful about fizzy drinks and alcohol - it is easy to forget when you are having fun! Please see the section on What should I eat and drink for more information..
- Take a holdall and plenty of plastic bags to help dispose of any wet items. Be sure you know what to do and practice your routine before you go away.
- If you are going to a hotel, contact the place where you will be staying, and, if possible, obtain a single room.
- Find out whether there is a washing machine and tumble dryer available - and ensure that you have sufficient washing powder or liquid. If not, take handwashing solution and perhaps a drying rack.
- Check whether bedding protection is provided. If not, find out the size of the beds in advance so that you can take your own.
- If you wear pads or use disposable draw-sheets or bed pads, take a bin liner so you can dispose of them discreetly.
- Check the bathing and showering facilities. If these are limited, take moist wipes, soap and a flannel. You might also like to use a room freshener.
- If you are going abroad, don't assume that other countries will have the same products that you use at home. If you wear pads at night, make sure you take sufficient quantities with you.
- On long flights, remember to take enough pads etc. in your hand luggage. Try to book an aisle seat near to the toilet.
Should I tell my girlfriend/boyfriend?
This can be a very sensitive issue but, if your relationship is close, and trusting, it is often helpful to say that you might wet the bed. If you don't, it could make you feel more tense and anxious and might put a barrier between you. You will probably find that your partner is very sympathetic and will support your efforts to become dry at night. You might prefer to use the medication desmopressin, if it works for you, to help you feel more confident if you start sleeping with your partner.