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.

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