Psychological Causes of Bedwetting: An In-Depth Look

Psychological Causes of Bedwetting

Bedwetting, also known as nocturnal enuresis, is a common condition that affects approximately 5-7 million children and adolescents in the United States. While there are several medical causes of bedwetting, psychological factors can also play a significant role.

In this blog article, we will examine the psychological causes of bedwetting and provide an in-depth overview of how mental and emotional issues can contribute to nighttime incontinence.

What is Bedwetting?

Bedwetting refers to involuntary urination during sleep past the age when bladder control is expected. Bedwetting is considered primary if the child has never established bladder control and secondary if they start wetting again after at least six months of dry nights.

Bedwetting can occur in children and teenagers up to age 18 but is most common in those under the age of 10. While genetics and medical issues like a small bladder can cause bedwetting, mental and emotional factors are also strong influences.

Let’s explore some of the main psychological causes of bedwetting and how they impact nighttime continence.

1. Stress and Anxiety

Stress and anxiety are two of the most common psychological triggers for bedwetting. When children experience emotional turmoil, it can manifest physically in a loss of bladder control at night.

Starting a new school, bullying, problems at home, or traumatic events can all heighten stress and anxiety levels. The pressure of these emotions overwhelms the child, making it difficult to interrupt sleep to use the toilet consciously.

Children may also subconsciously wet the bed as a reflection of inner turmoil. Their loss of control over their bladder mirrors feeling out of control in waking life. Bedwetting can be the mind’s way of expressing internal stress the child cannot verbalize.

2. Low Self-Esteem

Children with low self-esteem due to bedwetting may fall into a vicious cycle. The embarrassment of waking up in soaked sheets damages self-confidence. This intensifies stress, further worsening the bedwetting.

Kids may feel shame and like they are abnormal. Teasing from siblings or schoolmates can accelerate plummeting self-esteem. This cycle escalates anxiety and makes it very difficult for children to gain nighttime bladder control.

3. Developmental Delays

Immaturity in a child’s nervous system can play a role in bedwetting. If the nerves controlling the bladder and urethra have not developed properly, the brain cannot receive signals from a full bladder or coordinate the body to wake up.

Developmental delays, autism spectrum disorders, ADHD, and other conditions impacting the nervous system are linked to a higher rate of bedwetting. The child is not at fault, but their body and brain cannot remain dry throughout the night.

kid sleeping on his hands

4. Sleep Issues

Problems with sleep quality and depth are connected to bedwetting. Some sleep disorders like sleep apnea may increase bedwetting risk. When children are not getting restful sleep, they cannot rouse from deep sleep to use the bathroom.

An overcrowded bedroom or co-sleeping with parents can also lead to disturbed sleep. The child does not transition easily between sleep cycles and cannot consciously wake to urinate. Improving the sleep environment and treating sleep disorders may help reduce bedwetting episodes.

5. Major Life Events

Big changes in a child’s life can trigger the onset or worsening of bedwetting. Examples are starting at a new school, moving to a new home, arrival of a new sibling, divorce or separation, or losing a loved one.

Even positive life events can cause emotional upheaval. The child regresses back to bedwetting in response to the disruption of their regular routine and sense of security. Patience, support, and acknowledging their feelings help children adapt.

6. Genetics

Heredity plays a key role in bedwetting. Children are more likely to struggle with nighttime continence if a parent also dealt with the issue as a kid. Much of this is due to genetics impacting the development of bladder control neural pathways.

If one or both parents experienced bedwetting, their children have a 44% chance of struggling with it. Having two parents with a history increases the odds to 77%. Genetics establishes a biological vulnerability, interacting with psychological factors that either improve or exacerbate bedwetting.

7. Psychological Treatment Options

Addressing the psychological side is an integral part of helping children overcome bedwetting.

kid sleeping carboard box

Treatment Strategies for Overcome Bedwetting

Here are some treatment strategies that can be combined with medical management:

Counselling: Working with a therapist helps kids share their feelings, gain support, and learn coping skills for anxiety and self-esteem issues.

Prescription Medications: Drugs like imipramine work on the nervous system to reduce bedwetting episodes.

Bedwetting Alarms: Alarms detect moisture and rouse the child to interrupt urination and re-train the brain.

Positive Reinforcement: Praise, encouragement, and rewards motivate kids and boost self-confidence.

Scheduled Awakenings: Waking the child at set times to use the bathroom can establish a regular toilet habit.

Hypnosis: Hypnosis retrains the mind and nervous system to prevent uncontrolled urination.

Acupuncture: Fine needles in pressure points may enhance nervous system functioning to reduce bedwetting.

The most effective approach combines psychological and medical therapies tailored to the child’s needs. Patience, support, and a shaming-free environment also help kids overcome bedwetting challenges.

girl sleeping in spring garden

The Psychological Impact of Bedwetting

Bedwetting can have profound emotional effects and psychological consequences. Let’s explore some of the ways ongoing bedwetting impacts children’s mental health and self-image:

  • Damaged self-esteem from feeling abnormal, shame, and embarrassment
  • Anxiety about others finding out about their struggles
  • Social isolation and withdrawal from friends and activities
  • Depression from being bullied or teased about bedwetting
  • Feelings of guilt for placing stress on parents
  • Low motivation to achieve nighttime dryness
  • Frustration and helplessness over lack of control
  • Stress over being different from siblings and peers
  • Anger at the unpredictability of when wet nights occur
  • Fatigue from disrupted sleep or wearing moisture alarms
  • Bladder preoccupation interfering with focus at school
  • Regression or behavioural issues as an expression of internal distress
  • Secretly washing sheets to hide the condition from parents

Providing empathy, support, and treatment is crucial to preventing bedwetting’s negative psychological effects. Being patient and understanding helps children maintain a healthy self-image despite ongoing struggles with incontinence.


Bedwetting stems from a complex interplay of hereditary, medical, and psychological factors. Stress, low self-esteem, developmental delays, sleep disturbances, major life events, and genetics all contribute to loss of nighttime bladder control. Psychological components play a major yet often overlooked role.

Addressing sources of emotional distress, tailoring treatment to the child’s needs, and fostering a supportive environment is key to helping kids overcome bedwetting challenges. With compassion and patience, children can achieve self-confidence and bladder control. Learn here more about sleep health tips and strategies.