BEDWETTING (nocturnal enuresis), which is instinctive urination at night while sleeping, is common in children, and studies suggest that it can be effectively managed through supportive and compassionate parenting, and not through shaming or blame.

A broad cross-section of literature shows that normal bedwetting occurs among children aged 0-5 years, but other pieces of literature suggest that it can even occur up to children aged 10 and above years. Having a positive attitude towards bedwetting children is crucial to prevent stigma or frustration, according to researchers Dipak Khadke, Prabha Dasila, Nitin Kadam, and Mohd Saeed Siddiqui.

In their article titled “A Descriptive Study to Assess the Awareness and Attitude of Parents Regarding Nocturnal Enuresis Among Children” published in 2024 the researchers categorise bedwetting into two: primary and secondary bedwetting.

“Primary nocturnal enuresis consists of failing to have built up urinary self-restraint around evening time, while secondary enuresis alludes to the advancement of enuresis after a significant stretch of set up urinary self-restraint.”

David Bromberg, who is a medical doctor, of Emotional Health Committee Maryland Chapter American Academy of Paediatrics, says “consideration should be given to possible medical causes when secondary night-time bedwetting occurs. Anything that increases urinary output (glycosuria, diuretics), irritates the bladder (infection), or decreases bladder capacity by compressing the bladder (external mass or constipation) may cause night-time bedwetting.”

According to Khadke et al. (see above), Neha Gaonkar et. al (2018) say that bedwetting frustrates parents, and children consider it as one of the “terribly humiliating experience” especially when it persists. “For a child with involuntary bedwetting, the mere thought of sleeping over at someone’s house is fearful and anxiety-filled that his or her secret will be discovered.”

Some parents shame or blame their bedwetting children, thus aggravating their condition which may lead them to develop low self-esteem which disrupts their normal rhythm of life. Several times, I have stressed that children’s upbringing needs more parental skills than mistreatment, humiliation or shouting at children.

Children do not become better persons simply because they are harshly treated or disciplined, but because they feel loved and supported to develop high self-esteem and confidence so that they can make the best out of their situation.  

From International Children’s Continence Society’s diagnostic standards, bedwetting “can be identi­fied when no other symptoms are affecting the lower urinary tract or a history of bladder dysfunction.”

The researchers conclude that the education of the parents will help efficiently manage their children with various behavioural modification strategies, which in turn help them develop control over the bladder and improve their quality of life.

Other researchers such as Buket Agar, Metin Gurgoze and Aslihan Kara in their article titled “A Novel Approach to the Management of Children with Primary Nocturnal Enuresis” published in 2025 suggest that although delayed maturation of the central nervous system has been widely discussed as a contributing factor to bedwetting, precise mechanisms underlying it remain incompletely understood.

While this can be one factor, the researchers suggest that other factors have been implicated in the pathogenesis of primary nocturnal enuresis, which include nocturnal polyuria (producing a large volume of urine at night), reduced bladder capacity, sleep and circadian rhythm (the body internal clock based on a 24-hour day) disturbances, and genetic predisposition.

The researchers suggest that screening for vitamin B12 and vitamin D, and ferritin (a protein that stores iron in the body) deficiencies, even in the absence of other symptoms, and the addition of new supportive treatment to the management of bedwetting may lead to treatment success.
In their study of 150 participants, they found that, when the participants’ deficiencies were treated during a 3 to 6-month follow-up, [bedwetting] occurring fewer than two nights per week, was achieved in 77.6 per cent, 72.7 per cent, and 78.4 per cent of patients deficient in vitamin B12, D and ferritin, respectively.

According to the researchers, of the 150 participants only 21 (14 per cent) had no detectable vitamin deficiencies. However, low serum vitamin B12 levels were observed in 118 patients (78.6 per cent), while a decrease in vitamin D levels were identified in 62 participants (41.3 per cent), concurrent below-normal levels of both vitamin D and vitamin B12 were observed in 51 participants (34 per cent), and ferritin deficiency was detected in 26 participants (17.3 per cent), all of whom also exhibited deficiencies in either vitamin B12 and/or vitamin D.

The researchers argue that “several studies have demonstrated that vitamin B12 deficiency in children may lead to involuntary urination and defecation, potentially due to demyelination-associated axonal degeneration.” Likewise, they say that “vitamin D receptors are widely distributed throughout the body, including in both skeletal and smooth muscle cells, as well as in the detrusor muscle and the urothelium of the bladder. Vitamin D is thought to modulate bladder function by suppressing sensory signalling during the bladder filling phase, thereby helping to reduce detrusor overactivity.”

Therefore, a deficiency in vitamin D “may lead to uncontrolled bladder contractions and contribute to the development of an overactive bladder.”  As regards ferritin deficiency, the researchers say that “it remains unclear whether iron supplementation, when administered alongside other vitamin therapies, contributed independently to the achievement of dry nights.”

In their study, they found that ferritin levels below 10 nanograms per millilitre (ng/mL) were considered indicative of iron storage deficiency. According to an open educational resource (OER), ferritin (iron) deficiency, often part of broader iron deficiency anaemia, shows a significant link with bedwetting, especially in children. Hower, the OER cautions that more research is needed to ascertain the exact mechanism and if treatment improves symptoms.

Researchers Emre Aygun, Sibel Tugce Aygun, Yelda Turkmenoglu, Ahmet Irdem, Hasan Dursun in their article titled “Impact of Nocturnal Enuresis on Health-Related Quality of Life in Children” published in 2024 involved 100 bedwetting children and 100 non-bedwetting children together with their parents as a control group. 

The schoolchildren were aged between 6 and 16 years old. It was conducted in Turkey. The researchers suggest that bedwetting can interfere with the healthy psychological development of the child as well as their school performance and interpersonal relations. Citing Kilicoglu et al. (2014) they say the author showed parental scolding or punishment causes a significant reduction in the quality of life in bedwetting children. 

They explain that such behaviour may cause a stressful condition associated with poor quality of life. Thus, they suggest, a supportive parental attitude that tolerates and disregards bedwetting events is essential to improve the quality of life of bedwetting children.