5 Things Every Parent Should Know About Bedwetting

Bedwetting isn’t a behaviour, and your child isn’t the problem!

If you’re reading this in the midst of yet another middle-of-the-night sheet change, first of all: you’re not alone. As a paediatric Occupational Therapist with a focus on pelvic health, feeding, and sensory regulation, bedwetting (or nocturnal enuresis) is a topic I chat about a lot with clients… And it’s rarely just about the bladder!  

First: What’s Actually Normal?

Here’s something that surprises a lot of parents: staying dry during the day and staying dry at night are two different milestones. Nighttime dryness typically comes around 10 months after consistent daytime dryness. If your child just figured out daytime toileting but hasn’t quite mastered nighttime, that’s completely developmentally normal.

Bedwetting is also more common than most people realize and affects around 15-20% of five-year-olds and 10% of children by age seven (American Academy of Pediatrics, 2023; Daley et al., 2024; Thiedke, 2022). Clinically, bedwetting past the age of seven that occurs more than two times per week is worth paying closer attention to. Not because something is necessarily wrong, but because there are usually real, addressable reasons behind it!

It’s also worth knowing that big life changes (like a new sibling or a major family transition) can temporarily disrupt a child’s previously established bladder control. This is normal, and usually resolves on its own.

5 Reasons Bedwetting Happens (And What to Do About Them)

Bedwetting rarely comes out of nowhere. Here are five contributing factors every parent should know about.

1. Adequate Daytime Hydration

This is one of the most effective and most overlooked tools for preventing bedwetting at night. When kids aren’t well hydrated during the day, they often end up chugging water at dinner or bedtime, which predictably leads to a full bladder overnight.

Aim for consistent, spread-out fluid intake during waking hours and taper off in the hour or two before bed. The goal isn’t fluid restriction; it’s fluid timing.

2. Constipation

Constipation is one that surprises a lot of parents. The rectum sits directly behind the bladder, and when it’s carrying a backlog of stool (even in children who appear to have “regular” bowel movements), it puts pressure on the bladder and reduces its capacity. That same pressure can also compromise the pelvic floor’s ability to maintain urethral contraction during sleep, making nighttime leaks more likely. In fact, one small but compelling study found that 83% of children were dry within three months once constipation was treated (Hodges & Anthony, 2012)!

Focus on fibre-rich foods, good hydration, and regular toilet time.

3. Breathing Obstruction

Does your child snore, breathe through their mouth at night, or sleep restlessly? These can be signs of sleep-disordered breathing, and there is a strong link between disrupted breathing during sleep and bedwetting (Su et al., 2011).

When a child’s airway is obstructed, the body activates the parasympathetic nervous system (aka the rest-and-digest part of our nervous systems) at the wrong times, disrupting hormonal regulation (including vasopressin, the hormone that reduces nighttime urine production) and impairing bladder control. If you notice any of these signs, it’s worth raising with your paediatrician for further investigation.

4. Core Strength

The pelvic floor is part of the core, and when a child has a weak core, the pelvic floor is often weak too, meaning they may not have the capacity to feel the urge to void, and even when they do, they may not have the muscular ability to hold on long enough to make it to the bathroom.

This gap between sensation and action is a significant piece of the bedwetting puzzle. Active play, climbing, rolling, balancing, and floor-based movement all support core and pelvic floor development; another reason movement-rich environments matter for kids at every age!

5. Interoceptive Awareness

Interoceptive awareness refers to our ability to sense what’s happening inside our own bodies: knowing when we’re hungry, thirsty, tired, or need to use the bathroom.

Some children, particularly those with sensory processing differences, have difficulty tuning into these internal signals. If your child regularly misses hunger cues, doesn’t notice thirst until they’re very thirsty, or seems caught off-guard by sudden bathroom urgency, this could be part of the picture. Supporting interoceptive awareness through body-based play, mindfulness, and OT can make a meaningful difference, not just for toileting but for overall regulation and well-being.

The #1 Thing NOT to Do

The most important thing I want parents to hear is this: bedwetting is not a behaviour. It’s not defiance, a choice, laziness, or a bad habit. Bedwetting is a physiological event with multiple contributing factors, and it isn’t your child’s fault! That’s why sticker charts miss the point entirely.

A sticker chart assumes that staying dry is a behavioural choice, implying that your child has the physical, neurological, and interoceptive capacity to simply decide not to wet the bed. That’s not a fair assumption and placing that expectation on a child can cause shame, anxiety, and regression. Instead, focus on addressing the underlying contributing factors above, and approach your child with curiosity rather than correction.

When to Seek Support

If your child is over the age of seven and bedwetting is occurring several times a week, or if you’ve been managing it for awhile without improvement, it may be time to look deeper. Paediatric pelvic health sits at the intersection of the body systems involved in bladder and bowel control, and it’s more connected to feeding, sensory regulation, and development than most people realize. You don’t have to figure this out alone!

Ready to get to the root of what’s going on? Reach out to a paediatric pelvic OT in your area and take the first step toward supporting you and your child.

Sarah Comandante is a Registered Occupational Therapist (MScOT) at Coven Health Collective in Calgary, with a focus on paediatric pelvic health, infant and child feeding, sensory regulation, and developmental support for children from birth to 5 years. She takes a play-based, family-centred approach rooted in co-regulation and nervous system safety, because kids learn best when they feel seen, settled, and supported. Find her at covenhealthcollective.com or on Instagram.

References

American Academy of Pediatrics. (2023). Nocturnal enuresis in teens. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx 

Hodges, S. J., & Anthony, E. Y. (2012). Occult megarectum: A commonly unrecognized cause of enuresis. Urology, 79(2), 421–424. https://doi.org/10.1016/j.urology.2011.10.015

Daley, S. F., Gomez Rincon, M., & Leslie, S. W. (2024, December 11). Enuresis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK545181/

Su, M. S., Li, A. M., So, H. K., Au, C. T., Ho, C., & Wing, Y. K. (2011). Nocturnal enuresis in children: Prevalence, correlates, and relationship with obstructive sleep apnea. Journal of Pediatrics, 159(2), 238–242. https://doi.org/10.1016/j.jpeds.2011.01.036

Thiedke, C. C. (2022). Enuresis in children: Common questions and answers. American Family Physician, 106(5), 545–553. https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html