by Dr. Tiffani S. Bacon, PT
Founder of The Bladder Breakthrough™ | Pediatric Pelvic Health Specialist

7 Hidden Causes of Pediatric Incontinence Every Parent Should Know

If you’re the parent of a child who still wets the bed, you’re not alone. Nocturnal enuresis—the clinical term for nighttime bedwetting—affects up to 20% of 5-year-olds and 10% of 10-year-olds worldwide. While most children eventually outgrow it, research indicates that the rate of spontaneous resolution is only about 14% per year [Caldwell et al., 2005]. For many families, bedwetting is not just a minor inconvenience; it can be a major source of stress, affecting a child's self-esteem, sleep quality, and social confidence.

What if we told you that many of the causes of pediatric incontinence are underdiagnosed, misunderstood, or simply overlooked?

In this article, we’ll explore seven research-backed, clinically relevant causes of bedwetting that every parent should be aware of. Our goal is to provide a science-driven, compassionate approach to supporting your child through this challenging condition.

1. Neurodevelopmental Delays in Brain-Bladder Communication

Bedwetting is often perceived as a behavioral issue. However, functional MRI (fMRI) studies reveal that bedwetting may be linked to delayed development in areas of the brain responsible for executive control and arousal, including the anterior cingulate cortex (ACC) and prefrontal cortex [Kreydin et al., 2025; Luijten et al., 2014]. These brain regions help regulate the communication between the bladder and the brain during sleep.

In children with delayed neural signaling, the bladder may become full without the brain effectively signaling the need to wake up and urinate. This phenomenon is particularly common in children with ADHD, ASD, post-concussive symptoms, or other neurodevelopmental disorders.

2. Emotional Stress and Childhood Trauma

Emotional wellbeing plays a significant role in pediatric bladder health. Studies show that children who experience post-traumatic stress, family disruption, or chronic anxiety are more likely to develop secondary enuresis (bedwetting that reappears after a period of dryness) [De Young et al., 2021].

Triggers may include bullying, divorce, hospitalization, or moving homes. These emotional stressors can dysregulate the autonomic nervous system and alter bladder control during sleep.

Providers are increasingly encouraged to use a trauma-informed care framework, focusing on empathy, emotional safety, collaborative decision-making, and empowerment [Oh et al., 2018].

3. Gut Microbiota and the Bladder-Gut Axis

Emerging research into the gut-bladder axis shows that imbalances in gut microbiota, known as dysbiosis, can impact bladder health and immune function. Children with altered gut flora may be more susceptible to urinary tract infections (UTIs), inflammation, and even enuresis [Le et al., 2025; Mocanu et al., 2023].

Gut health influences the body’s inflammatory response and has a direct line to the brain via the vagus nerve—a key player in autonomic bladder control.

Practical takeaway: Prioritize a high-fiber, low-sugar diet, encourage hydration, and consider discussing probiotics with your child’s pediatrician.

4. Environmental and Lifestyle Factors

Your child’s environment might be more influential than their DNA.

Studies have shown that family history, diet, caffeine intake, stressful home dynamics, and even temperature and altitude can affect incontinence risk . One study even found that weather patterns—like rainfall and sunshine—impact UTI prevalence in children.

While genetics do play a role in pediatric enuresis, lifestyle and environmental factors are equally important. Excessive consumption of caffeine, carbonated beverages, and sugary drinks has been linked to nighttime bedwetting. Other culprits include sleep deprivation, academic pressure,  constipation, and lack of physical activity [Abdeen et al., 2024; Li et al., 2025].

Creating structured routines, limiting bladder-irritating foods, and supporting good sleep hygiene are non-invasive ways to support your child’s progress.  Set a calming evening routine with reduced sugar, screen-free time, and pre-bed bathroom visits.

5. Telehealth and Remote Support Options

Access to pediatric specialists is a known challenge, particularly for families in rural areas. Fortunately, telemedicine has become a valuable tool in managing pediatric incontinence. According to Bladt et al. (2024), virtual bladder health consultations can deliver comparable or better outcomes than traditional in-person care.

Telehealth platforms allow providers to monitor treatment compliance, provide bladder training exercises, and evaluate progress without requiring repeated in-office visits. This can be a game-changer for busy families seeking consistent, evidence-based support.

Research shows telehealth can improve outcomes, increase satisfaction, and reduce costs. Platforms like The Bladder Breakthrough™ integrate telehealth into their treatment tools, giving families consistent access to support, therapy, and education.

6. Behavioral vs. Pharmacological Interventions

Parents are often presented with medication (e.g., desmopressin) as a first-line solution for bedwetting. However, behavioral therapies have been shown to be equally or more effective, especially when introduced early. These may include:

• Bladder training games
• Enuresis alarms

• Reward charts and bedtime routines

• Positive reinforcement programs

• Timed voiding and bladder training

And they come with zero side effects.

Pharmacologic treatments may be helpful in select cases, but they can come with side effects and are typically recommended for short-term use only [Fedorkow, 2019].  That said, desmopressin, anticholinergics, or even off-label use of antidepressants may still be part of the picture for some children—but only after exploring behavioral first.

Therefore, Start conservative, stay consistent.

7. Cultural Influences and Parental Beliefs

Different cultures have different expectations—and that matters when it comes to bedwetting.

Some parents view incontinence as laziness or a moral failing. Others may delay treatment due to stigma or lack of awareness.  Cultural beliefs significantly shape how families approach pediatric incontinence. In some communities, bedwetting may be stigmatized or seen as a behavioral failure, which can delay intervention. Other families may feel too embarrassed to seek medical advice [Mena et al., 2015; Khan et al., 2025].

Educational outreach that is culturally sensitive, non-judgmental, promote inclusion, provides trauma-informed language, and rooted in science is crucial. Empowering parents with tools, language, and knowledge that respects their values can dramatically improve outcomes, which is key in shifting to the following narrative:  Incontinence is a medical condition, not a behavioral choice.

What we believe shapes how we support.

Conclusion: An Empowered Path Forward

Bedwetting is far more than a developmental inconvenience—it is a complex, multifaceted condition that touches on neurology, nutrition, mental health, family culture, and environmental factors.

And yes, many kids outgrow bedwetting. But many don’t—and they deserve better than just waiting it out.

By understanding the diverse causes of pediatric incontinence, we can move away from blame or shame and toward research-backed, compassionate care. Whether your child is managing stress, struggling with sensory regulation, or just hasn’t yet developed mature neural-bladder signaling, there are paths forward.

At The Bladder Breakthrough™, we provide:

• Virtual therapeutic courses

• Bladder training games (like Bladder Defender™)

• Parent guides

• Culturally-sensitive, medically accurate resources

Your child’s bladder story is uniquely theirs—and we’re here to help you decode it.

That’s the mission of The Bladder Breakthrough™. We combine cutting-edge science with compassion, fun, and clinically-backed tools to help families turn frustration into freedom.

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✅ Join our 5-Day Challenge
✅ Download the Bladder Defender™ App
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Because your child deserves dry nights, and you deserve peace of mind.

References

• Kreydin E., et al. (2025). Neural Mechanisms of Poststroke Urinary Incontinence. Stroke.

• Luijten M., et al. (2014). Inhibitory Control in Behavioral Addictions. JPN.

• Caldwell P., et al. (2005). Bedwetting and Toileting Problems in Children. MJA.

• De Young A., et al. (2021). Medical Trauma and Childhood Enuresis. J Pediatr Psychol.

• Oh DL., et al. (2018). Childhood Adversity and Pediatric Health Outcomes. BMC Pediatr.

• Le T.T., et al. (2025). Microbiota and Pediatric Bladder Health. Gut Microbes.

• Mocanu A.M., et al. (2023). Kidney-Gut Axis in Children. Nutrients.

• Abdeen R.R.H., et al. (2024). Environmental Influences on Pediatric Incontinence. QJM.

• Li C., et al. (2025). Weather and Pediatric UTI Trends. Front Public Health.

• Bladt L., et al. (2024). Digital Tools for Pediatric Incontinence. IJMR.

• Fedorkow D. (2019). Effectiveness of Behavioral vs. Pharmacologic Incontinence Treatments. AIM.

• Mena N.Z., et al. (2015). Cultural Influences in Pediatric Care. Childhood Obesity.

• Khan A., et al. (2025). Parenting Norms and Cultural Perceptions. SSR Archives.

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