Bedwetting still nightly problem for some older kids, but it’s no shame
SINGAPORE — Bedwetting is a common early childhood problem but for some older children here, waking up in a urine-soaked bed is a regular affair.
While most children start to grow out of bedwetting from the ages of three to five years old, as many as one in 20 continue to have bedwetting episodes at the age of 10.
SINGAPORE — Bedwetting is a common early childhood problem but for some older children here, waking up in a urine-soaked bed is a regular affair.
While most children start to grow out of bedwetting from the ages of three to five years old, as many as one in 20 continue to have bedwetting episodes at the age of 10, said Dr Isaac Liu, a consultant at the National University Hospital’s (NUH) division of paediatric nephrology.
The division sees an average of two cases of bedwetting, or nocturnal enuresis, each week. Among its patients are 12 and 13 year olds seeking treatment to stay dry through the night.
Parents usually seek help when the bedwetting causes frustration in the family or becomes a social inconvenience, such as the child being afraid to go for an overnight school camp, said Dr Liu.
Dr Christelle Tan, a specialist in paediatric medicine and consultant at Raffles Specialists — Holland V, sees around 10 new cases of bedwetting in older children above the age of seven each year.
Among her patients was a 12-year-old boy whose mother sought medical attention to ease his anxiety of participating in overnight school camps. He would wet his bed once a week.
“I read that some boys take longer with bladder control so I wasn’t too worried. But he was worried about going on school trips, and that was my catalyst for seeing a doctor,” said the boy’s mother, a 49-year-old teacher who did not want to be named.
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WHY BEDWETTING OCCURS IN OLDER CHILDREN AND TEENS
It is not known why some children take a longer time to grow out of bedwetting. According to medical experts, it could be hereditary. Bedwetting tends to run in families and children who wet their beds would likely have parents who experienced the same issue in childhood.
Children with intellectual disabilities or attention deficit hyperactivity disorder tend to have bedwetting that is difficult to treat, said Dr Liu, who added that boys are twice as prone to bedwetting as girls though the cause is not known.
It can also be triggered by medical illness or psychological stress, such as adjustment to a new environment. In some cases, constipation can worsen the problem.
Some children may have delayed maturation of responses that prevent bedwetting, such as when their brains are unable to stop the passing of urine or wake them up to do so when their bladders are full. These responses begin to mature around the age of three to five, said Dr Liu.
“Control over bedwetting requires the child to be aware of a sensation of a full bladder, and then, the higher centres of the brain act to inhibit inappropriate passing of urine or wake the child up to pass urine,” he said.
“Inappropriate bedwetting occurs when there is a delay in developing these maturational responses.”
In 20 to 30 per cent of children who experience bedwetting, it could be because their bodies are not producing normal amounts of a naturally occurring hormone called the anti-diuretic hormone during sleep. The hormone is important in reducing urine production at night, said Dr Chong Siew Le, consultant at KK Women’s and Children’s Hospital’s (KKH) nephrology service. Sometimes, bedwetting may signal a more serious medical issue.
There may be a need to assess for other medical conditions such as diseases that result in excessive urine production or urinary tract infection, said Dr Chong. This is especially if the child also has urinary symptoms in the day.
If the child has bladder symptoms such as frequent urination, urgency in urination, difficulty initiating a stream, straining or hesitating during urination, terminal dribbling or a feeling of incomplete bladder emptying, he or she could have bladder dysfunction, said Dr Liu.
Other red flags include bowel incontinence and bedwetting that comes back after staying dry for more than six months, he added.
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SEEK HELP, STEER CLEAR OF PUNISHMENTS
While bedwetting is not a life-threatening condition, experts TODAY spoke to urged parents not to sideline the issue as it can severely impact a child’s self-esteem, social development and body image.
“Bedwetting is quite a sensitive personal problem, especially for older children. They tend to be embarrassed about it but bedwetting is hardly the main issue when they visit the doctor. It is only highlighted when I ask parents more about their child’s general health,” said Dr Tan.
It is important for parents not to punish, shame or blame the child for bedwetting, said experts.
In a recent study published in the journal Child Abuse and Neglect, children who were punished for wetting the bed were more likely to be depressed and had worse overall quality of life compared to those who were not punished.
“Bedwetting is involuntary and the child is actually helpless and has no control over it. In fact, punishing or blaming the child for bedwetting may lead to psychological problems in the child,” said Dr Chong.
Dr Chong advised parents to seek medical help if the child continues to wet the bed after the age of five, especially if the episodes are frequent or if the child develops bedwetting after staying dry for more than six months.
Children who suddenly develop bedwetting after staying dry at night for a long time should see a doctor, regardless of age, added Dr Tan.
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OVERCOMING BEDWETTING
With treatment, the majority of bedwetters improve significantly and overcome their nighttime accidents.
“The first thing I do is to assure the child and parent that (bedwetting) is nothing to be ashamed of and instill confidence in the child that it will improve,” said Dr Liu.
Helping children understand their own condition and providing reassurance will help them become less anxious or embarrassed by the problem, said Dr Tan.
Lifestyle changes, behavioural interventions, as well as strategies to heighten awareness of bedwetting episodes and tracking the child’s progress can help reduce symptoms.
Other measures include having the child use the toilet just before bedtime and limiting the last water intake to four hours before bedtime. Water has a transit time of four hours as it has to be absorbed into the blood and filtered through the kidneys, said Dr Liu.
There are other treatment methods such as the use of bedwetting alarms, which detect wetness and alerts the user to get up and empty their bladder, as well as prescription medication. The medication causes the kidney to absorb more fluid from the urine and should only be used under careful doctor supervision, added Dr Liu.
According to him, most of the children he treated overcame bedwetting within three to six months. “It won’t immediately disappear within a day after initiating the treatment programme but the improvement will be obvious within a month,” he said.
For Dr Tan’s 12-year-old patient, coping strategies such as not drinking too much water before bedtime and ensuring the room temperature was not too cold helped.
He was also prescribed medication to help him stay dry during a four-night school camp and three-week overseas family trip. His mother said that he has not had a single bedwetting episode in the last six months.
“The fact that we don’t see nighttime pants here, which are so common in supermarkets in New Zealand and the United Kingdom for teenagers up to 15 or 16 years old, adds to the stigma of bedwetting,” said the boy’s mother.
“I never told my child off for it. It’s not like he could help it. I think it’s important for parents to accept that bedwetting is not abnormal and not make a big deal out of it.”
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