What happens if you need to pee while you’re asleep?

Have you ever wondered what happens when nature calls in the middle of the night, while you’re deep in slumber? It’s a question that might not cross your mind during the day, but it unveils a fascinating world of biological coordination between your brain and your bladder. As you sip water throughout the day, your body diligently processes the excess liquid, transforming it into urine. Your bladder becomes the reservoir for this bodily waste, and when it’s time to release it, your body sends you the signal. But what about those nighttime hours, when dreams take over and consciousness seems distant? How does your body navigate the delicate balance of sleep and the call of nature? (

Photo credit: Many children wet the bed at night. Olga Rolenko/Moment via Getty Images

Even when you’re tucked in bed, your body remains a hive of activity. It doesn’t truly switch off; rather, it adapts to the rhythms of slumber. Breathing continues, digestion keeps churning, and yes, the process of making pee doesn’t hit the pause button. ( It’s a symphony of coordination between your brain and your bladder, a dance of signals and responses that’s both intricate and awe-inspiring. This intricate choreography between your brain and bladder is a topic that’s close to my heart as a pediatric urologist. Understanding these processes, and sometimes their miscommunication, is a vital aspect of my work.

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Now, let’s journey back to the early stages of life. In the world of babies and young kids, the bladder has a remarkable quality: reflexes. It automatically knows when it’s time to squeeze those muscles and empty the bladder. Since babies can’t consciously control this process, they sport the ever-reliable diaper. However, as these little ones grow, so do their bladder muscles and nerves. This growth grants them greater control over their bladder, paving the way for toilet training, a rite of passage usually completed by the age of 3 or 4 in the U.S. It’s during this phase that kids learn to listen to their bodies, feel when the bladder is reaching its limit, and respond accordingly. () They grasp the art of “holding it” until they can safely reach the toilet – a feat of coordination between brain and bladder.

But here’s the twist in the tale: most children initially conquer daytime bathroom visits. It’s a different story when nighttime arrives, shrouding the world in darkness. You see, the slumbering brain operates in its own realm. Unlike daytime, it doesn’t heed the calls of loud noises or the beckoning of bright lights. ( It’s as if your brain switches to a “sleep mode,” unresponsive to external stimuli. Imagine sleeping soundly through a thunderstorm, oblivious to its fury until others recount it in the morning. ( Your brain didn’t process those loud claps; it was too engrossed in the world of dreams.

This parallel can be drawn to bladder signals. The bladder dutifully fills with urine around the clock, even while you’re cozily lost in dreamland. It sends signals to your brain when it’s brimming with liquid. ( To ensure your sleep remains uninterrupted, your brain often instructs the bladder to bide its time until morning beckons. Occasionally, when the urgency is undeniable, your brain might rouse you from slumber, nudging you to relieve your bladder’s burden. ( While it’s normal to wake up for a midnight bathroom run now and then, most older kids can drift through the night without this interruption. (

However, here’s where the plot thickens. ( The delicate harmony between brain and bladder can occasionally falter. The brain might miss the bladder’s message entirely, or, even if it receives it, it might struggle to convey the “hold on” directive. In cases of urgency, the brain might fail to wake the body, leading to an automatic reflex in the bladder – an involuntary squeeze that empties itself, all while you rest, blissfully unaware in your bed.

Bedwetting, scientifically termed nocturnal enuresis, is more common than one might imagine. ( Roughly 15% of kids aged 5 to 7 experience nighttime wetting, and some teenagers grapple with it too. It’s a challenge that affects more boys than girls, often carrying a familial legacy, as parents or relatives may have grappled with similar nocturnal incidents in their youth. (

The reasons behind nighttime wetting are multifaceted. Growing brains and developing bodies can mean that nighttime communication between the brain and bladder takes longer to mature. Some bodies manufacture more urine during nighttime hours, increasing the risk of bladder overflow. Others have petite bladders that swiftly reach their capacity. ( Additionally, issues with sleep or being a deep sleeper can make it tough to rouse oneself for that crucial midnight bathroom trip.

Yet, there is a silver lining. For most kids who contend with bedwetting, it’s a phase that they eventually outgrow as their brains and bodies continue their developmental journey. They reach a point where they slumber through the night, unburdened by nocturnal bathroom visits, or their bodies awaken them when the bladder calls. If bedwetting persists as a concern, practical measures can be taken. Reducing liquid intake in the evening or visiting the bathroom right before bedtime can minimize the likelihood of nighttime bladder overload. ( Bedwetting alarms are another useful tool, training the body to awaken in response to the bladder’s signals. However, if bedwetting becomes a persistent issue in older children, the guidance of a medical professional is highly advisable. (

In the grand scheme of human development, the nighttime journey of brain-bladder coordination is a fascinating one, fraught with twists and turns. As we grow, we evolve, and the dance between brain and bladder matures, offering the gift of uninterrupted slumber. So, the next time you embark on that nightly voyage to dreamland, spare a thought for the silent symphony unfolding within you – a testament to the wonders of our intricate biology.

Yael Wolfe

Writer, photographer, artist, and big, bad wolf. I’m a writer, photographer, and artist. I use my work to explore what it means to be a woman in this world.

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