Symptoms & Causes of Bladder Control Problems & Bedwetting in Children

What are the signs and symptoms of bladder control problems in children?

Losing urine by accident is the main sign of a bladder control problem. Your child may often have wet or stained underwear—or a wet bed.

Young girl squatting to avoid leaking urine.
Squatting, leg crossing, and heel sitting can be signs of an overactive bladder.

Daytime Wetting

Signs that your child may have a condition that causes daytime wetting include

  • the urgent need to urinate, often with urine leaks
  • urinating 8 or more times a day, called frequency
  • infrequent urination—emptying the bladder only 2 to 3 times a day, rather the usual 4 to 7 times a day
  • incomplete urination—not fully emptying the bladder during bathroom visits
  • squatting, squirming, leg crossing, or heel sitting to avoid leaking urine

Bedwetting

Nighttime wetting is normal for many children—and is often not considered a health problem at all—especially when it runs in the family.

At ages 5 and older, signs that your child may have a nighttime bladder control problem—whether due to slow physical development, an illness, or any cause—can include

  • never being dry at night
  • wetting the bed 2 to 3 times a week over 3 months or more
  • wetting the bed again after 6 months of dry nights
Doctor listens to a boy in her office.
Your child’s doctor can suggest when treatments may help control bedwetting.

When should my child see a doctor about bladder control problems?

If you or your child are worried about accidental wetting, talk with a health care professional. He or she can check for medical problems and offer treatment, or reassure you that your child is developing normally.

Take your child to a health care professional if there are signs of a medical problem, including

  • symptoms of bladder infection such as
    • pain or burning when urinating
    • cloudy, dark, bloody, or foul-smelling urine
    • urinating more often than usual
    • strong urges to urinate, but passing only a small amount of urine
    • pain in the lower belly area or back
    • crying while urinating
    • fever
    • restlessness
  • your child dribbles urine or has a weak urine stream, which can be signs of a birth defect in the urinary tract
  • your child was dry, but started wetting again

Although each child is unique, providers often use a child’s age to decide when to look for a bladder control problem. In general,

  • by age 4, most children are dry during the day
  • by ages 5 or 6, most children are dry at night

Seek care right away

If your child has symptoms of a bladder or kidney infection, or has a fever without a clear cause, see a health care professional within 24 hours. Quick treatment is important to prevent a urinary tract infection from causing more serious health problems.

What causes bladder control problems in children?

Bathroom habits, such as holding urine too long, and slow physical development cause many of the bladder control problems seen in children. Less often, a medical condition can cause wetting. Learn which children are more likely to have bladder control problems.

What causes daytime wetting in children?

Daytime wetting in children is commonly caused by holding urine too long, constipation, or bladder systems that don’t work together smoothly. Health problems can sometimes cause daytime wetting, too, such as bladder or kidney infections (UTIs), structural problems in the urinary tract, or nerve problems.

When children hold their urine too long, it can trigger problems in how the bladder works or make existing problems worse. These bladder problems include:

Overactive bladder or urge incontinence

Bladder muscles squeeze at the wrong time, without warning, causing a loss of urine. Your child may have strong, sudden urges to urinate. She may urinate frequently—8 or more times a day.

Underactive bladder

Children only empty the bladder a few times a day, with little urge to urinate. Bladder contractions can be weak, and your child may strain when urinating, have a weak stream, or stop-and-go urine flow.

Disordered urination

Muscles and nerves of the bladder may not work together smoothly. As the bladder empties, sphincter or pelvic floor muscles may cut off urine flow too soon, before the bladder empties all the way. Urine left in the bladder may leak.

What causes bedwetting in children?

Nighttime wetting is often related to slow physical development, a family history of bedwetting, or making too much urine at night. In many cases, there is more than one cause. Children almost never wet the bed on purpose—and most children who wet the bed are physically and emotionally normal.

Sometimes a health condition can lead to bedwetting, such as diabetes or constipation.

Boy sleeping under colorful blanket.
Bedwetting often runs in families, where it is usually a normal growth pattern, not an illness.

Slow physical development

Between ages 5 and 10, slow physical development can cause your child to wet the bed. Your child may have a small bladder, deep sleep cycles, or a nervous system that’s still growing and developing. The nervous system handles the body’s alarms—sending signals about a full or emptying bladder—and the need to wake up.

Family history

Bedwetting often runs in families. Researchers have found genes that are linked to bedwetting. Genes are parts of the master code that children inherit from each parent for hair color and many other features and traits.

Making too much urine

Your child’s kidneys may make too much urine overnight, leading to an overfull bladder. If your child doesn’t wake up in time, a wet bed is likely. Often this excess urine at night is due to low levels of a natural substance called antidiuretic hormone (ADH). ADH tells the kidneys to release less water at night.

Sleep disorders

Sleepwalking and obstructive sleep apnea (OSA) can lead to bedwetting. With OSA, children breathe poorly and get less oxygen, which triggers the kidneys to make extra urine at night. Bedwetting can be a sign that your child has OSA. Other symptoms include snoring, mouth breathing, ear and sinus infections, a dry mouth in the morning, and daytime sleepiness.

Stress

Stress can sometimes lead to bedwetting, and worry about daytime or nighttime wetting can make the problem worse. Stresses that may affect your child include a new baby in the family, sleeping alone, moving or starting a new school, abuse, or a family crisis.

September 2017
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Stephan A. Zderic, MD, Children’s Hospital of Philadelphia