Nocturnal / Secondary Enuresis


Nocturnal enuresis, also referred to as primary nocturnal enuresis, is the medical term for bedwetting.

Nocturnal enuresis applies specifically to children who have always wet the bed, as opposed to the other forms of bedwetting, including secondary enuresis (which is when a child has been dry for a consecutive period of six months and then starts wetting the bed again).

Bedwetting is an extremely common. In fact, up to 15% of five year olds and up to 5% of ten year olds wet the bed. Around 97% of children have grown out of bedwetting by the age of 12, so most cases are nothing to worry about and simply require some love and support.

The cause of bedwetting for a child who has always wet the bed is usually fairly common bladder development delays, amongst other causes, which generally iron themselves out over time.

What causes bedwetting?

If your child is going through a bedwetting phase, you’re probably wondering what’s causing it. The short answer is that it’s usually down to a minor developmental delay, which will straighten itself out over time. It’s quite rare for bedwetting to be caused by an underlying medical condition. The most common form of bedwetting is called primary nocturnal enuresis. This refers to when a child has never been dry at night. Common causes are things like genetics, a neurological development delay between the bladder and brain, or the underproduction of the antidiuretic hormone ADH that signals to the kidneys to produce less urine at night. The other type of bedwetting is secondary nocturnal enuresis. This refers to a child who has been dry for six months or more, and then starts to wet the bed. This is typical the result of underlying medical issues or by emotional factors. For children with primary nocturnal enuresis, it means your child’s bladder capacity has not developed to the point of being able to hold urine overnight. Children who wet the bed at night may have a nervous system that is slow to process the feeling of a full bladder. So your child does not wake up or respond to the messages sent from their bladder to their brain saying its full and needs emptying. As their body matures the messages sent from the bladder start to get through and your child learns to wake and go to the toilet. Most children who experience bedwetting haven’t reached this developmental stage yet. But don’t worry, they’ll get there soon. While deep sleeping certainly plays a role in bedwetting it is not the primary cause of why it happens in the first place. Deep sleeping just makes it even harder for children to response to the signal sent from their bladder telling them to ‘wake-up’. Secondary nocturnal enuresis is a little more complex. If your child has been dry at night for six months and they relapse back to bedwetting, it’s often a sign of emotional problems or stress. Common catalysts include big events, such as moving house, a new sibling, or starting school. Stressful situations, including tension in the home, death of a family member or pet, or being bullied at school can also cause your child to start wetting the bed again. Other causes of secondary bedwetting include minor medical conditions, such as constipation or a urinary tract infection. In very rare cases, bedwetting can be caused by diabetes. One thing to remember through all of this is that the cause is never laziness. It’s important to remain calm and not to take out any frustration on your child, even though it can be a real pain to change sheets every night. Provide some extra support to your child by using DryNites® Pyjama Pants or BedMats. It gives them a little more independence and they’re an effective safety net at night.

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Nocturnal enuresis has various causes; not all children will wet the bed for the same reasons.
These are the most common causes of nocturnal enuresis:

  • Neurological development delay: If your child’s nervous system is still developing, the bladder may not be able to signal the brain to wake up for a bathroom visit.
  • Genetics: If both parents wet the bed as children, there is a 75% chance that their child will also experience bedwetting. The chances decrease to 40% if it’s just one parent, and 15% if neither you nor your partner were affected.
  • Under-production of anti-diuretic hormone (ADH): ADH is a hormone that regulates urine production while we sleep. Some children do not produce enough of this handy hormone, which causes their bladders to become full during the night.
  • Small bladder capacity: Sometimes a delay in bladder development can result in low capacity and cause the need to urinate during the night.



Bedwetting can be a source of emotional distress to child sufferers and is often damaging to self-esteem. Providing lots of love and emotional support during this time is necessary and will help reassure your child.

  • Explain to your child that this is just a very common phase they’ll eventually grow out of.
  • If they’re old enough to use the internet, help them research bedwetting causes and management techniques – being informed can help them feel more in control of the situation
  • Never punish your child for wetting the bed, as this can lead to feelings of shame, anxiety, and confusion.



There are a range of bedwetting products on the market, which help reduce stress for both parents and children. If your child is old enough, discuss these products with them first and allow them to choose which ones they feel comfortable using.

  • DryNites Pyjama Pants: These absorbent pants are designed to be lightweight and discreet, just like real underwear.
  • Mattress protector: A quality mattress protector is a good investment when your child is going through the bedwetting stage.
  • Disposable bedwetting mats: Absorbent bedwetting mats add an extra layer of protection and are a good option to consider if your child’s bedwetting has become less frequent and they don’t wear pyjama pants every night.
  • Night light: A night light can make your child feel more comfortable visiting the bathroom when it’s dark.



Causes of secondary enuresis vary and tend to fall into one of two categories; emotional and physiological. In most cases the trigger will not be a medical issue.

  • Urinary tract infection (UTI): UTIs can cause frequent urination and/or the need to urinate urgently in the sufferer. A simple urine test will help identify an infection, which can usually be treated easily with antibiotics.
  • Diabetes: Frequent urination is a symptom of type 1 diabetes. Your doctor will be able to run tests in order to figure out if this is the problem.
  • Neurological abnormalities: Even a slight imbalance in the nervous system can cause secondary enuresis.
  • Constipation: Blockages in the rectum can put pressure on the bladder and reduce its capacity to store urine overnight.
  • Obstructive Sleep Apnea: OSA can result in increased nighttime urine production, which can lead to a return to bedwetting.
  • Emotional stress: Big changes in a child’s life can cause emotional stress, which is a common trigger for bedwetting.



There are a number of things you can do if your child has started wetting the bed again.

  • Talk to your child, and try to think of anything that changed around the time the bedwetting started again, as a team. Write down all possibilities to discuss with your child and their GP.
  • Note whether your child is displaying any other sign of stress, such as irritability, headaches, outbursts or tantrums which are out of character, crying, or social withdrawal.
  • If you suspect a medical condition, you should visit a doctor as soon as possible and have your child undergo the required tests. It’s usually a good idea to rule out a medical problem anyway, even if you strongly suspect it’s a psychological cause.



Treatment for secondary enuresis will depend on the cause. Some medical conditions, such as UTIs are easy fixes and will usually disappear with a course of antibiotics, while others may be more serious.

Bedwetting caused by emotional stress can sometimes be a little trickier to deal with and your child may need to speak to a counsellor. Less traumatic stress triggers, such as anxiety about school exams or moving house, generally sort themselves out over time, but it’s still important to be supportive and try to help ease their anxiety.
You should always consult your child’s GP for guidance on how to treat secondary enuresis.

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