Bedwetting is a common problem among children all over the world. By the age of five, about 7% of boys and 3% of girls experience accidents regularly, as often as at least twice a week for a period of three months or longer. Often, the problem occurs only during night time sleep.
The medical term for wetting the bed at night is Nocturnal Enuresis and it means involuntary urination during sleep.
According to the Ministry of Health’s MyHealth portal most children will stop bedwetting by the age of five or six but studies have shown that between 10% and 15% of all children in the ages five to 12 years continue to wet their beds although they have no underlying kidney or urinary tract disorder. A study in Malaysia found that about 6.2% of seven to 12 year-olds are still bedwetting. These statistics are more or less similar to other Asian and Western countries.
An academic article further reports that bedwetting also occurs in 1–1.5% of Western teenagers in whom the impact leads to tremendous emotional turmoil, anxiety and reduced self-esteem. Although most parents show concern, some become annoyed and intolerant and even resort to punishment.
Bedwetting is, therefore, mostly misunderstood. The good news is that it often resolves by itself as the child grows up.
Don’t Shame Your Child
It is important to remember that your child is not bedwetting on purpose. He isn’t being lazy to get up and go to the toilet and he isn’t trying to be “naughty”. He can’t help it. He doesn’t know why it is happening and is probably more embarrassed or ashamed of it than you think.
“In general, 5%-10% of children aged five to 10 years have enuresis; 2%-3% in those aged 11-14 years; and 1%-2% in those above 15. In fact, in one out of 100 of these children, the problem may persist till adulthood,” said The Star in their 2018 article.
What is the Cause of Bedwetting?
A number of things can cause bedwetting. Some of the more common causes include:
- Genetic factors as it tends to run in families. There is a 15% incidence of enuresis in children from families without the problem, compared to 44% if one parent had the problem when young, and 77% of children when both parents were themselves bedwetters.
- Smaller bladder capacity. A very small bladder may not be able to hold urine for eight to 14 hours per night without incident.
- More urine production due to less Vasopressin. Some children produce more urine during sleep than do others. This may be due to a lower production of a hormone called vasopressin during sleep. Vasopressin is important for reducing urine production at night.
- Sleep disorders. Most bedwetters are said to be deep sleepers and do not wake up when their bladder is full. They may also have other sleep disorders like Bruxism (teeth grinding), heavy sweating during sleep and night terrors.
- Sleep Apnea and breathing problems have been associated with enuresis.
- Developmental delay. A delay in brain development or motor function may be interfering with toilet training.
- Medications your child may be taking. Some medications contain diuretics that can stimulate urination. Others may interfere with the mechanisms that allow your child to awaken from sleep in order to use the bathroom.
- Psychological factors are clearly contributory in a minority of children with enuresis. These children have experienced a stress such as parental conflict, trauma, abuse, or hospitalisation. In these few cases the wetting is seen as a regressive symptom in response to the stress.
- Constipation. If a child’s bowels are blocked with hard feces, it can put pressure on the bladder and lead to bedwetting.
- Urinary Tract Infection (UTI). The child may also have other symptoms associated with UTI such as fever and pain.
- Type 1 Diabetes. There are also other symptoms associated with Diabetes such as tiredness, weight loss, feeling thirsty and needing to go to urinate more often. Do have this checked out.
Types of Bedwetting
- If bedwetting occurs only at night in an otherwise healthy child, then it is known as Primary Nocturnal Enuresis.
- If bedwetting at night occurs along with daytime wetting (incontinence) – then it needs further evaluation by a doctor for the underlying cause.
- Secondary enuresis is bedwetting after a long period of night-time dryness. There may be other underlying disorders which include: UTI, spinal cord problems, bladder abnormalities, nervous system disorders, metabolic problems and even periodontal disease (teeth and gums/halitosis).
Does Bedwetting need Investigation?
Bedwetting is a childhood condition that is common and if it occurs only at night (primary nocturnal enuresis) with no other symptoms or signs of underlying abnormalities, then it is not associated with a major illness and will need no further investigation. However, complication may arise due to bedwetting.
What are the Complications?
- May cause low self-esteem in the child. Low self-esteem by itself can be a risk factor for psychiatric and other social disorders.
- Stress, exhaustion and frustration in the family as bedwetting is often an ongoing issue needing frequent bedsheet washing and mattress-drying.
How to Help Your Child Stop Bedwetting
1. Shift Times for Drinking: Increase fluid intake earlier in the day and taper it off later in the evening by dinner time.
2. Schedule Bathroom Breaks: Get your child to urinate on a regular schedule like every two to three hours during the day and go to the toilet once more just before going to bed.
3. Reward Success: Keep a journal to record the bedtimes. Everytime he achieves a dry night, reward him! Give him stars and lots of praise and encourage him to stay dry.
4. Eliminate Bladder Irritants: Eliminate caffeine in his diet such as cola, chocolate milk and cocoa, also cut citrus fruits and juices, artificial flavourings, dyes (especially red) and sweeteners. These can all irritate a child’s bladder.
5. Avoid Thirst Overload: Make sure your child drinks consistently throughout the day so that he is not over thirsty when he comes back from school and starts chugging down mugs and mugs of drinks. The faster one drinks, the faster urine fills the bladder.
6. Do not Wake the Child Up Randomly at Night to Urinate: This may lead to more tiredness for all parties concerned due to interrupted sleep.
7. Use a Bedwetting Alarm if all else fails: Bedwetting alarms are among the most effective and safest bedwetting treatments. Studies show alarm therapy is often successful with children over age seven. Bedwetting alarms are like a urination trainer. A special moisture sensor is placed inside the child’s pajamas that triggers a bell or buzzer when he starts urinating. The alarm is designed to awaken the child so he or she can get to the toilet and finish urinating. In the beginning, however, it is usually the parent who will be awakened to rouse the child to go to pee. The alarm should be used every night until he or she can go three to four weeks without a bedwetting episode. This usually takes two to three months, so you should be persistent and patient as your child masters nighttime bladder control. It also helps to put the potty near his bed so that he can have access to eliminate easily.
Other Helpful Tips
- Use waterproof mattress cover/quilt.
- Consider using absorbent pants.
- Use deodorant for the room and open windows for sunshine and fresh air to clear up moisture and odours.
- Shower in the morning before going to school.
For more Guides on Childcare, visit Motherhood.com.my.