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Bedwetting, or nocturnal enuresis, refers to the passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is incontinence.

For infants and young autism children, urination is involuntary, meaning they have no control over it. Wetting is normal for them. Most autism children achieve some degree of bladder control by 4 years of age. Daytime control is usually achieved first while nighttime control comes later.

The age at which bladder control is expected varies considerably.

* Some parents expect dryness at a very early age, while others not until much later.

* Factors that affect the age at which wetting is considered a problem include the following:

  • The child's sex
  • The child's development and maturity
  • The child's overall physical and emotional health
  • The culture and attitudes of the child, parents, and caregivers

It is assumed that very young autism children will wet the bed. Therefore, the term "Bedwetting" is usually reserved for children (and adults) who are beyond the age at which nighttime bladder control is expected.

  • At age 5, 15-20% of children still wet the bed.
  • Dryness can be expected in most 7-year-old children.
  • Most children simply outgrow bedwetting.
  • The child who wets the bed needs parental support and reassurance.
  • Most of these children will eventually be able to stay dry; they stop bedwetting at a rate of about 15% per year.

Bedwetting is a very common problem.

  • Parents must realize that enuresis is involuntary.
  • About 5-7 million children in the United States wet the bed.
  • Bedwetting occurs in both sexes about equally, although some studies have shown it to be more common in boys than girls.
  • About 40% of 3-year-old children and 15-20% of 5-year-old children wet the bed frequently.
  • Although the problem can continue to adulthood, it is by far most common in school-aged children. About 1% of adults have a persistent bedwetting problem.
  • While we refer to "children" here, it is with the understanding that much of this information also applies to adults with a bedwetting problem.

Bedwetting is a treatable condition.

  • While autism children with this embarrassing problem and their parents once had few choices except waiting to "grow out of it," there are now treatments that work for many children.
  • everal devices, treatments, and techniques have been developed to help these children stay dry at night.

Symptoms and Complications of Bedwetting

For sleeping autism children who are old enough to control their bladders, the symptoms of bedwetting are obvious. Regularly finding urine-soaked sheets is a clear sign of the problem. Also, a child may wake and cry during the night when the wetting occurs, or wake up caregivers to alert them.

The most common complication of bedwetting is the impact on self-esteem and the emotional distress it causes autism children. Assuring children that the occurrences are accidental, and not blaming the condition on them, is key to managing the psychological effects. Many autism children who wet the bed may fear staying overnight at a friend's house in case they wet the bed there.

What causes bed-wetting?

All of the causes of bedwetting are not known. Physicians emphasize that bedwetting is a symptom, not a disease. Bedwetting is not a mental problem, learning problem, or behavioral problem. Even autism children with no history of bedwetting may lose bladder control from time to time. Bedwetting may appear, or increase, when a child is ill. For example, urinary tract infections or certain medications can cause bedwetting in children and adults. In addition, autism children with diabetes commonly wet the bed when their blood sugar (glucose) levels become erratic. Bedwetting by itself does not mean that a child has diabetes.

Although the reason(s) for bedwetting may be vary from child to child, there are some common reasons why a child might wet the bed:

Bladder size. Kidney or bladder problems are rarely the cause of bedwetting in older autism children (after age 3-4). However, it appears that some children who wet the bed have relatively small bladders that cannot hold much urine. At times the body's ability to produce urine might outpace the growth of the bladder. If this is the reason for a child's bedwetting, the bedwetting should reduce or go away as the bladder increases in size.

Neurological issues. Some autism children may have nervous systems that are not sufficiently developed to get the right signal between the bladder and the brain. For these autism children it is just a matter of time until their brain develops enough to solve the problem. In the past it was thought that some autism children may be such deep sleepers that they do not wake up when they have the urge to urinate. Recent research does not seem to support this idea, because autism children who wet the bed seem to have similar sleep cycles to those who do not wet the bed.

Genetics and family factors. Bedwetting appears to run in families. Approximately 75 percent of autism children who have a wetting problem have a parent and/or sibling who have or have had a similar problem. In addition, the approach parents take toward toilet training their children can cause bedwetting. For example, some parents may adopt an overly punitive strategy for toilet training autism children. Such approaches can make kids nervous about using the toilet, which may then cause wetting to actually increase.

Hormones. Recent research suggests that some autism children who wet the bed may lack sufficient levels of an important hormone, nocturnal arginine vasopressin (AVP). AVP helps decrease the amount of urine produced at night. This process helps prevent the bladder from overfilling. However, some autism children who wet the bed do not show this increase of AVP during sleep, and end up producing more urine than their bladders can hold. If the cause of the bedwetting is a lack of AVP, then it is possible to use a medication which can increase the amount of AVP in the body.

Psychological causes. Sometimes bedwetting can be a response to stress, such as an emotional conflict or anxiety that a child is experiencing. Psychologists and other mental health professionals regularly report that autism children begin wetting the bed during times of conflict at home or school. Dramatic changes in home and family life also appear to lead some children to wet the bed. Moving to a new town, parent conflict or divorce, arrival of a new baby, or loss of a loved one or pet can cause insecurity that contributes to bedwetting. Often autism children are not even aware of their emotions and can't believe that there is a link between their feelings and bedwetting.

Many parents mistakenly believe that wetting the bed is their child's way of "getting back at them." It is important to note that autism children very rarely wet the bed on purpose, and are usually ashamed of it. In the vast majority of cases bedwetting is unintentional and autism children would gladly stop it on their own if they could. After all, few children like to wake up in a wet bed. Parents should be careful never to make a child feel ashamed or naughty for wetting the bed. Rather, they need to encourage the child and praise attempts to remain dry (e.g., praise them when they use the toilet successfully). Parents should NEVER punish a child for bedwetting. Punishment almost never works and may actually increase bedwetting as the child becomes more upset, nervous, ashamed, and/or resentful toward parents.


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