Bedwetting, also known as nocturnal enuresis, is a common challenge that many children naturally outgrow as they get older. However, for some, it persists beyond the age of five or six. In these cases, the issue may be linked to a variety of factors—both medical and non-medical.
While common causes like poor brain-bladder communication, constipation, and a weakened pelvic floor often contribute, underlying medical issues such as enlarged tonsils and adenoids can also play a role. Understanding these factors is crucial for parents making informed decisions about their child’s health. While enlarged tonsils and adenoids can contribute to bedwetting, it’s important to consider all possible factors before moving forward with any major medical interventions.
Tonsils, located at the back of the throat, are small lumps of tissue that play a role in the lymphatic system, helping the body fight infections.
When a child frequently has sore throats or infections, the tonsils can become enlarged. This swelling can block the airway, especially during sleep, leading to breathing problems such as snoring or sleep apnea. These breathing issues during sleep can interfere with a child’s ability to control bladder function, potentially leading to bedwetting.
Adenoids, similar to tonsils, are located higher up behind the nose and play a role in trapping germs that enter through the nasal passages as part of the body’s immune defense.
However, adenoids can become enlarged due to chronic infections or allergies. Swollen adenoids can block the nasal passages, causing mouth breathing during sleep, which disrupts sleep and may contribute to bedwetting. For more information on how allergies can contribute to bedwetting, see my post on allergies and bedwetting.
Chronic ear infections caused by enlarged adenoids may also lead to fluid buildup in the ears, affecting sleep quality. In some cases, grommets—small tubes inserted into the eardrum—are used to drain fluid and prevent ear infections, which may help reduce sleep disruptions and, in turn, decrease the likelihood of bedwetting.
Many children with enlarged tonsils or adenoids also develop the habit of mouth breathing, particularly at night. Mouth breathing can impact sleep quality, which can contribute to bedwetting. It can also affect conditions such as rhinitis, allergies, and asthma. Even after tonsil or adenoid removal, some children continue to breathe through their mouths out of habit, which may prevent full improvement.
Before considering major medical interventions, parents may want to explore whether mouth breathing is playing a role. Simple breathing exercises can often help encourage nasal breathing, improving sleep and bladder control.
The Buteyko Breathing Method is a set of breathing exercises designed to promote nasal breathing. This technique can be particularly helpful for children who habitually breathe through their mouth.
By retraining the body to breathe through the nose, Buteyko breathing may:
The Buteyko Method is gaining recognition as a useful approach for improving breathing and sleep quality. Studies show that children practicing Buteyko breathing experienced better asthma control, reduced medication use, and improved lung function over a few months (Effect of the Buteyko Breathing Technique on Asthma Severity Control, 2024). Additionally, research on breathing exercises found that they can help reduce nocturnal enuresis in children with sleep-disordered breathing, highlighting the link between proper breathing and bladder control (The Effect of Breathing Exercises on Nocturnal Enuresis in Children with Sleep-Disordered Breathing, 2013).
If your child struggles with mouth breathing, Patrick McKeown explains simple techniques to help transition to nasal breathing in his video Stop Mouth Breathing in Children. Additionally, his talk at the Mater Hospital, Your Mouth Does Nothing for Breathing, explores the science behind nasal breathing and how it affects sleep, attention, and overall health.
Encouraging nasal breathing through Buteyko exercises may be a simple and effective step for parents to try before moving forward with more invasive treatments.
For some children, removing enlarged tonsils or adenoids, or inserting grommets, may help reduce bedwetting, though results can vary. Here’s how:
Improved Sleep Quality: Enlarged tonsils and adenoids can cause obstructive sleep apnea (OSA), leading to snoring and poor sleep quality. By removing these tissues, the airway can be cleared, potentially leading to better sleep and fewer wet nights.
Reduced Mouth Breathing: Addressing enlarged tonsils or adenoids can help eliminate mouth breathing, which often leads to poor sleep.
Better Ear Health: Inserting grommets helps alleviate ear infections and fluid buildup, potentially reducing sleep disturbances and improving bladder control at night.
Experts often highlight the connection between sleep apnea and bedwetting, particularly in children. Dr. Dennis Kitsko, an otolaryngologist at the Children’s Hospital of Pittsburgh, notes that children with sleep apnea may struggle to stay dry at night:
“Children with sleep apnea can be difficult to rouse, which may cause the bedwetting. But not every child with sleep apnea will wet the bed, and not every bedwetter will have sleep apnea.”
While surgery can be beneficial in some cases, it is not always a guaranteed solution.
If your child is showing several of the following symptoms, consider trying the Buteyko Method and/or consulting an ENT (Ear, Nose, and Throat) specialist:
Snoring – Persistent snoring or loud breathing during sleep can be a sign of airway obstruction, often caused by enlarged tonsils or adenoids. According to Dr. Linda Dahl, an ear, nose, and throat doctor at Lenox Hill Hospital in New York City:
“Snoring in children is abnormal. Children snore because their tonsils and adenoids are enlarged, and they end up getting other behaviors that go along with sleep apnea, including bedwetting.”
Waking Up Tired – If your child frequently wakes up feeling tired or lethargic, it may indicate disrupted sleep due to breathing difficulties or issues like enlarged tonsils.
Mouth Breathing – Habitual mouth breathing can lead to dry mouths, sleep disturbances, and an increased risk of bedwetting. Even if tonsils and adenoids are not enlarged, mouth breathing can persist, which is why addressing it with breathing exercises like the Buteyko Method can be helpful.
Frequent Runny Nose or Colds – Chronic nasal congestion or recurrent colds may point to enlarged adenoids or tonsils, which could be contributing to sleep problems and possibly bedwetting.
Recurrent Ear Infections – Frequent ear infections can disrupt a child’s sleep quality. Inserting grommets can help relieve this issue, promoting better sleep patterns.
Bedwetting – All of the above factors can contribute to bedwetting. If it persists beyond the typical age range or becomes more frequent, it may be worth exploring potential medical causes.
Many other factors can contribute to bedwetting, including medical issues such as diabetes, hormonal imbalances, and urinary tract infections (UTIs). Additionally, lifestyle elements like poor brain-bladder communication, constipation, bladder irritants, emotional stress, sleep quality, and fluid intake also play significant roles.
These diverse causes highlight the importance of considering both medical and lifestyle factors when seeking solutions. Given this range of potential contributors, starting with non-invasive treatments is often a helpful first step.
The Stay Dry at Night program equips parents with valuable insights and helps children build better brain-bladder communication, increase sensation awareness, and develop effective bladder control. By addressing these varied aspects, this approach offers a comprehensive strategy that may help your child achieve dry nights.
It is important to approach bedwetting with a holistic mindset, recognizing that multiple factors can contribute to persistent wet nights. While sleep disruptions caused by enlarged tonsils and adenoids may play a role, other influences—such as mouth breathing, poor brain-bladder communication, constipation, emotional stress, and lifestyle habits—can also be contributing factors. Addressing these together provides the best chance for long-term improvement.
Before considering major medical interventions, exploring whether mouth breathing is playing a role can be a valuable step. Simple breathing exercises, such as the Buteyko Method, may encourage nasal breathing, improve sleep quality, and reduce bedwetting—sometimes without the need for surgery.
Every child is different, and what works for one may not work for another. Some children may benefit from surgical interventions, while others may respond well to non-invasive strategies like breathing retraining, sleep optimization, and addressing lifestyle factors. A comprehensive approach that considers both medical and behavioral aspects is often the most effective way to help children achieve consistent dry nights and better overall well-being.
Abdollohi-Fakhim, S., et al. (2016). Effects of adenotonsillar hypertrophy corrective surgery on nocturnal enuresis of children. Niger Med J, 57(1), 69-73.
Dr. Sanu. “Adenotonsillectomy Can Improve Bedwetting in Children with Obstructive Sleep Apnoea.” Retrieved from https://drsanu.com/blog/adenotonsillectomy-can-improve-bedwetting-children-obstructive-sleep-apnoea/
Hassan, E. E. M., Abusaad, F. E., & Mohammed, B. A. (2022). Effect of the Buteyko breathing technique on asthma severity control among school-age children. Egypt J Bronchol, 16(1), 45. doi: 10.1186/s43168-022-00149-3. PMID: 9308119.
HealthDay. “Tonsil Removal Might Cure Bedwetting in Some Kids With Sleep Apnea.” Retrieved from https://www.healthday.com
InformedHealth.org. “Enlarged tonsils and adenoids: Learn More – Surgery for enlarged tonsils or adenoids.” Available from: https://www.ncbi.nlm.nih.gov/books/NBK536875/
InformedHealth.org. “Overview: Enlarged tonsils and adenoids.” Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536881/
Kidney.org. “Snoring and Bedwetting.” Retrieved from https://www.kidney.org/snoring-and-bed-wetting
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Mayo Clinic. “Bedwetting (Nocturnal Enuresis) Symptoms and Causes.” Retrieved from https://www.mayoclinic.org
MedlinePlus. “Adenoids.” Retrieved from https://medlineplus.gov/adenoids.html
McKeown, P. (2015). The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You. HarperOne.
Nestor, J. (2020). Breath: The New Science of a Lost Art. Riverhead Books.
Park, S., et al. (2016). Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing. The Laryngoscope.
Somuk, B. T., et al. (2016). Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy. Am J Otolaryngol.
Vagedes, K., Kuderer, S., Ehmann, R. et al. (2024). Effect of Buteyko breathing technique on clinical and functional parameters in adult patients with asthma: a randomized, controlled study. Eur J Med Res, 29, 42. https://doi.org/10.1186/s40001-023-01634-1
Ginny Laver BA (Hons), MSc, NLP, Dip. THP is a Clinical Hypnotherapist and Neuro Linguistic Programming (NLP) practitioner who specialises in helping children learn how to stop bedwetting naturally.
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Have you or someone you know experienced changes in bedwetting after having enlarged tonsils or adenoids removed or after inserting grommets? Whether it led to success or didn’t go as planned, your story could help other families going through the same journey.
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