​Bedwetting In Children

Bedwetting is a common and troublesome problem in some children.

It is viewed traditionally as part of growing up, but when it persists beyond early childhood, it becomes unacceptable and can be very stressful and distressing to the afflicted children and their families. Many parents are worried when their school-going child continues to wet his/her bed at night.

The following attempts to address some of the common questions asked about bedwetting, with the aim to provide some facts and dispel fallacies on this subject. The reviews provided are by no means exhaustive and you should discuss with the doctor or therapist when in doubt.

What Is Bedwetting?

It is uncontrollable wetting while asleep in an otherwise healthy child beyond early childhood.

Most bedwetters seeking treatment in Singapore are:

• 5 years or older with majority between 7 to 12 years old
• Suffering from frequent bedwetting of at least twice per week the majority being almost every night

Is Bedwetting A Problem That Needs Therapy?

Yes, especially when the child is already at school going age and the wetting is frequent.

• Studies have shown that constant bedwetting can adversely affect the psychosocial development of the child causing low self-esteem and poor social adjustment
• It can also cause resentment and anxiety in parents and other family members
• It constitutes a source of embarrassment and deters the sufferer from healthy outdoor activities like overnight camping and travelling

In Singapore, it has been found that bedwetters and their parents sought treatment for the following reasons :

• Restricted activities involving overnight sleep outside home
• Parental fatigue
• Disrupted sleep for the household
• Fear of underlying disease

How Common Is Bedwetting?

Actual incidence of bedwetting is unknown in Singapore. However, it is believed to be quite common and there is an increasing number of cases seeking treatment in recent years.

• Its occurrence in Singapore might be under-reported as it had been found that many sufferers and parents were too embarrassed to seek treatment while others thought that there is no effective treatment; thereby suffering in silence
• In Western countries, the problem is common with a reported incidence of 10% among 7-year-olds, 5% among 10-year-olds and 1% in the adult population

What Causes Bedwetting?

The exact cause or causes are unknown. Various factors or causes that have been implicated include:

• Hereditary cause. Bedwetting often runs in a family.
• Inability to wake up to void urine. Bedwetters are known to be deep sleepers.
• A delay in maturation of bladder control at night. Bedwetting tends to improve with time and the majority of sufferers will ultimately become dry. But this may take years and a small percentage of them (1%) will continue bedwetting beyond puberty.
• Lack of the production of a naturally occurring body hormone called Anti-Diuretic Hormone (ADH) during sleep in 20-30% of children with bedwetting. This hormone is important for reducing urine production at night.

Is Bedwetting Due To Psychological Problems?

Absolutely not.

• Bedwetting is involuntary and the child is actually helpless and has no control over wetting
• In fact, punishing or blaming a child for bedwetting may actually lead to psychological problems in a child

Are there underlying diseases like kidney and bladder problems in bedwetting?

No. The vast majority of bedwetters are healthy with no underlying diseases.

• Only rarely is bedwetting associated with other diseases. When this occurs, it is almost lways associated with symptoms like wetting in the day, pain on passing urine, fever, excessive thirst. large urine volume or failure to grow.
• When bedwetting occurs in a child who has been dry for months, this may be due to an underlying urine infection or sometimes due to stressful conditions like a change of environment, change of school etc.

Can bedwetting be treated?

Yes. With treatment. the majority of sufferers can become dry or improve significantly. Although bedwetting can resolve spontaneously, if left alone, this may take several years. To date, there are two established treatment strategies that have claimed about 70% to 80% success rate. They are the use of:

• Bedwetting alarm.
• Desmopressin -a synthetic anti-diuretic hormone (ADH) that can concentrate and reduce urine production.

How does bedwetting alarm help?

• Bedwetting alarm is a form of conditioning therapy. It comprises a urine sensitive pad formed by a series of flexible wires connected to an alarm unit. The detector pad is placed on the child's underwear when he goes to sleep. The moment a few drops of urine come into contact with the pad, the alarm will be triggered, awakening the child who will then cease voiding, get out of bed and complete voiding in the toilet. Several nights of being awakened in this manner results in the development of a conditioned response, enabling the child to hold his urine even when his bladder is full.
• Thus, it takes time to train the bladder. Results are often seen only after weeks of therapy.
• This method is effective in 70% to 80% of bedwetters but it requires high motivation and patience on the part of the bedwetters and their parents. as well as constant support from therapists.

How does desmopressin help?

Bedwetters typically produce copious and diluted urine during sleep. To reduce this excessive urine production, a synthetic anti-diuretic hormone called desmopressin is used at bedtime to give an extra boost to the body to help concentrate the urine.

• Up to 70% of bedwetters can respond to desmopressin treatment.
• An initial trial of treatment over two weeks is necessary to assess response. If there is satisfactory response, treatment is continued for at least three months, after which treatment needs to be reviewed. Some bedwetters need a longer period of treatment .

Are there any side effects to desmopressin treatment? What precautions should be taken?

There are rarely, if any, significant side effects. However, as desmopressin reduces water with excretion from the body, it can potentially cause water retention if a child continues drinking excessively after taking the medication. Side effects occur occasionally and include headache, loss of appetite, abdominal cramps and rarely, fits. An important precaution for those children using desmopressin is to avoid drinking water before bedtime.

Where can I get help?

You can seek advice and treatment from your doctor.