Alex falls into an extremely deep sleep almost every night. He sleeps so deeply that you could set off a fire alarm next to his bed and he probably wouldn't hear it. Even having to pee doesn't wake up Alex, and he sometimes wets the bed while he's asleep. Alex feels embarrassed about his problem, but he's not alone. About one out of every 100 teens wets the bed. Most of them outgrow the problem, though.

What Is Enuresis?

The medical name for not being able to control your pee is enuresis (pronounced: en-yuh-ree-sis). Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that occurs at night. (Involuntary urination that happens during the day is known as diurnal enuresis.)

There are two kinds of enuresis: primary and secondary. If a person has primary nocturnal enuresis, that person has wet the bed since he or she was a baby. If it's secondary enuresis, the condition developed at least 6 months - and even several years - after a person learned to control his or her bladder.

What Causes Enuresis?

The bladder is a muscular receptacle, or holding container, for pee (or urine). It expands (gets bigger) as urine enters and then contracts (gets smaller) to push the urine out.

In a person with normal bladder control, nerves in the bladder wall send a message to the brain when the bladder is full; the brain then sends a message back to the bladder to keep it from automatically emptying until the person is ready to go to the bathroom. But people with nocturnal enuresis have a problem that causes them to pee involuntarily at night.

Doctors don't always know the exact cause of nocturnal enuresis. They do have some theories, though, on what may contribute to a person developing the condition:

• Hormonal problems. A hormone called antidiuretic hormone, or ADH, causes a person's body to produce less urine at night. But some people's bodies don't make enough ADH, which means their bodies may produce too much urine while they're sleeping.
• Bladder problems. In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine. Some teens and adults also have relatively small bladders that can't hold a large volume of urine.
• Genetics. Teens with enuresis often have a parent who had the same problem at about the same age. Scientists have identified specific genes that cause enuresis.
• Sleep problems. Some teens, like Alex, may sleep so deeply that they do not wake up when they need to pee.
• Medical conditions. Medical conditions that can trigger secondary enuresis include diabetes, constipation, and urinary tract infections. Spinal cord trauma, such as severe stretching of the spinal cord resulting from a fall, sports injury, auto accident, or other event may also play a role in enuresis, although this is rare. And abnormal development of the spinal cord can also lead to enuresis.
• Psychological problems. Things such as divorce, the death of a friend or family member, a move to a new town and adapting to a new school and social environment, or family tension can all feel overwhelming. It's not uncommon for people to feel stressed out during their teenage years, and stress can disturb sleep patterns.

Doctors don't know exactly why, but more than twice as many guys as girls have enuresis. It is frequently seen in combination with ADHD.

How Is Enuresis Diagnosed?

If you're having trouble controlling your urine at night, it's a good idea to visit the doctor to learn more about nocturnal enuresis and to rule out the possibility of a medical problem.

In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history. He or she may ask about sleep patterns, bowel habits, and urinary symptoms - such as an urge to pee a lot or pain or burning when you pee. Your doctor may also discuss any stressful situations that could be contributing to the problem. If the cause appears to be emotional, the doctor may recommend that you talk with a therapist or counselor who can help get to the root of the problem.

The initial exam will probably include a screening urinalysis and urine culture. In these tests, a person's urine is examined for signs of disease. Most of the time in people with nocturnal enuresis, these test results come back completely normal.

How Is It Treated?

There are several things doctors can do to treat bedwetting, depending on what is causing it. If an illness is found to be the cause, which is not very common, it will be treated. If the history and physical examination do not suggest a specific medical problem, and the urine tests are negative, there are several behavioral approaches that can be used for treatment:

• Manage what you eat and drink before bed. People with nocturnal enuresis can take some basic steps to prevent an overfull bladder by decreasing the amount of fluids they drink before going to bed. Although you'll want to cut back on the amount of fluid you drink in the evening, no one should go to bed thirsty. You can reduce the chances that you'll wet the bed by going to the toilet just before bedtime.

It may help to avoid eating certain foods in the evening: Foods that can irritate the bladder include coffee, tea, chocolate, and sodas or other carbonated beverages containing caffeine. And some people find that avoiding dairy foods at night may prevent the deep sleep that can contribute to enuresis.

• Imagine yourself dry. Using a technique called positive imagery, where you think about waking up dry before you go to sleep, can help some people stop bedwetting. Some people find that rewarding themselves for waking up dry also works.
• Use bedwetting alarms. Doctors and nurses sometimes prescribe bedwetting alarms to treat teens with enuresis. According to the National Kidney Foundation, 50% to 70% of cases of enuresis respond to treatment with these moisture alarms. With these alarms, a bell or buzzer goes off when a person begins to wet the bed. Then, you can quickly turn the alarm off, go to the toilet, and go back to sleep without wetting the bed too much. Don't get discouraged if the alarm doesn't help you stop wetting the bed immediately, though. It can take many weeks for the body to unlearn something it's been doing for years. Eventually, you can train yourself to get up before the alarm goes off or to hold your urine until morning.

People who sleep very deeply may need to rely on a parent or other family member to wake them up if they don't hear the alarm. The key to bedwetting alarms is waking up quickly - the sooner a person wakes up, the more effective the behavior modification for telling the brain to wake up or send the bladder signals to hold the urine until the morning.

Sometimes doctors treat enuresis with medication - although this is not usually the first course of action because no medication has been proven to cure bedwetting permanently, and the problem usually returns when the medication is stopped. In people whose bodies don't make enough ADH, doctors sometimes prescribe a man-made form of this hormone to decrease urine buildup during the night. Other medications relax the bladder, allowing it to hold more urine.

If you're worried about enuresis, the best thing to do is talk to your doctor for ideas on how to cope with it. Your mom or dad can also give you tips on how to cope, especially if he or she had the problem during adolescence. The good news is that scientists and doctors are learning more and more about bedwetting and are constantly developing new treatments for the problem.