Bedwetting in the Potty-Trained Kid

You’ve made it through the diaper years, celebrated dry nights, and finally felt like the potty training phase was behind you. Then it happens – your child starts having accidents again. Understandably, this can be confusing, frustrating, and even alarming for parents.

Secondary enuresis (incontinence or bedwetting) is a condition where a child who’s been dry for at least six months starts wetting again, either during the day, at night, or both. Before you start blaming that extra juice box or questioning your potty training approach, it’s important to know there could be underlying reasons behind this change, and they’re rarely about laziness or defiance. There are medical, emotional, and physiological reasons this happens, and most of them are treatable with the right support.

Why the Unexpected Detour

By age five, around 15% of children still experience some form of urinary incontinence, most often at night.1 Primary enuresis refers to children who have never achieved consistent nighttime bladder control, while secondary enuresis happens after a long period of dry nights but then starts wetting the bed again.

Here are some of the most common causes:

Stressful Life Events – Big transitions, like the birth of a sibling, moving to a new home, or a divorce, can disrupt a child’s sense of security. In some children, that emotional upheaval shows up as bedwetting. The communication between the brain and the bladder can become less coordinated during times of stress, leading to accidents.
Constipation – It might not seem connected, but constipation is a frequent culprit, present in up to 56% of children with bedwetting issues.1 A full rectum presses against the bladder, decreasing its capacity and triggering uncontrolled bladder muscle contractions. Some kids may not even meet the clinical criteria for constipation, but still have bowel patterns that affect bladder function, like hard stools or infrequent bowel movements.
Sleep Patterns – Some children sleep so deeply that they don’t wake in response to a full bladder. Plain and simple. In other cases, obstructive sleep apnea (a condition that causes temporary pauses in breathing during sleep) can disrupt the normal production of antidiuretic hormone (ADH), which helps regulate urine output at night. This results in nocturnal polyuria (excessive nighttime urine production) and increases the risk of accidents.¹
Bladder Capacity – Even if a child has a normal-sized bladder, their functional capacity, or the amount of urine they can comfortably hold while awake or asleep, may be low. This makes them more prone to accidents if they don’t void regularly or if the urge to urinate isn’t strong enough to wake them from sleep.
Medical Conditions – Secondary enuresis can also be a symptom of an underlying medical condition. While enuresis is a normal phase in childhood, when it becomes excessive or nothing seems to be helping, it may be time to consider alternative approaches. Some of the conditions that are common include diabetes (symptoms include frequent urination, excessive thirst, and weight issues), pinworms that can irritate the urinary tract, or neurological conditions like seizures. (Whatever you do, do not get yourself in a panic! Start simple by talking to a pediatric urologist.)
Structural Issues – Sometimes the cause can be related to anatomical differences or underlying physical conditions. For instance, some children are born with a blockage in the urethra that can make it hard to fully empty the bladder. Some girls may have a urinary tube that connects in an unusual spot, leading to leaks because the bladder doesn’t get proper control. These issues usually develop before birth and may not show up until a child starts having frequent accidents or urinary tract infections.

Tips for Dry Sheets and Confidence

It isn’t unusual for enuresis to resolve spontaneously; it often happens as children seem to simply grow out of it. For secondary enuresis, that’s a little different, and it’s helpful to have some tools available to get through it. One of the most important things to remember is that punishing a child for bedwetting is never helpful.

Sometimes, discussing results can motivate children to adopt the good habits they need to find a resolution. Try to figure out if they want to make a sleepover a goal, or maybe they’re just tired of waking up wet. Once you understand what they’re working toward, you can create a plan that makes sense for your family.

Start with the basics. Ensure your child uses the bathroom regularly throughout the day, ideally every couple of hours. That means right after waking up, before leaving the house, throughout the day, when they return home, and again before going to bed. If they’re at school, a note from a doctor can help them get bathroom breaks when needed, instead of waiting for scheduled times.

You’ll also want to examine your hydration habits. Many kids don’t drink enough during the day and then chug water or juice in the evening because they’re so thirsty. That makes nighttime accidents more likely. Try shifting most of their fluid intake earlier in the day and cutting back after 5 p.m., but only if they’ve had enough earlier. You don’t have to go to extremes, just a small shift to help the body adjust.

If constipation is part of the picture, it needs to be addressed also. Even if your child doesn’t seem constipated, watch for signs like hard stools, long gaps between bowel movements, or straining. Sometimes, it’s as easy as staying well-hydrated to increase bowel motility or ensuring that nutritional needs are being met. If you find that constipation is more of an issue than you once thought, talk to your pediatrician about what else could be going on.

Although it may seem counterintuitive, skip diapers or training pants when at home and use them sparingly for special events or when away, as they can hinder progress. Instead, use mattress covers, have extra bedding nearby, and protect the skin with a gentle barrier, if needed. The goal is to make cleanup easy without making your child feel bad about it, while also encouraging the motivation to get up if they need to use the bathroom at night.

Sticker charts or small rewards can be helpful for reinforcing healthy daytime potty habits, especially in elementary-aged children. These positive habits during the day, like regular bathroom breaks and going potty before bed, can support overall bladder health and may gradually lead to fewer nighttime accidents. However, it’s important to understand that bedwetting (primary enuresis) is usually not under a child’s control, so rewards tied to dry nights aren’t effective. Instead, focus on encouragement and praise for daytime efforts, and offer grace and reassurance when accidents happen. This helps build confidence and supports long-term progress without adding pressure.

Progress isn’t always fast, and there might be a few steps forward and one step back, but that’s okay. With a bit of patience and support, most kids get back to dry nights and the confidence that comes with them.

Also, be aware that sometimes more intensive therapies may be warranted. Behavioral therapy with an alarm system is one option – it can help kids learn to wake up when their bladder is full. They take some time and commitment, but they can also be effective for retraining the brain and bladder communication. If nothing is working after a few months, medication can be another tool to consider, especially for things like sleepovers or camp. Your provider can help guide you and your child to the right decision.

When You’re Ready for Help

Don’t forget about the impact of enuresis on self-esteem and social development. Children may feel embarrassed, avoid sleepovers, or struggle academically. Parents may feel helpless or frustrated, especially if they are unsure of what is causing the change.

And yet, this is one of the most common urologic concerns in pediatrics. With the right evaluation and a tailored plan, most children outgrow enuresis completely.

If your child has been dry for months and suddenly starts having accidents again, don’t assume the worst or go too long trying to manage it alone. Our team at Georgia Urology specializes in the evaluation and treatment of voiding dysfunction. We understand the emotional and practical toll this can take on your family, and we’re here to help your child move forward with comfort and confidence.

Schedule a consultation today to explore the next steps in your child’s care. Let’s get to the bottom of what’s going on and get your little one back to dry days and peaceful nights.

Reference:

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