Bedwetting, clinically known as nocturnal enuresis, is a condition that remains largely shrouded in silence despite its prevalence among children.
According to Dr Andrew Ferreirinha, a paediatrician at Mediclinic Kloof, it is a normal developmental concern that often brings distress to families.
“Bed wetting is not a behavioural problem or an outcome of poor parenting; it is something that many children will outgrow with proper support, and if necessary, medical intervention,” he explained.
In South Africa, approximately 16% of children between the ages of five and ten experience bedwetting, with the condition occurring twice as often in boys as in girls.
Yet, the societal stigma associated with bedwetting often discourages families from seeking the help they need, leaving many parents feeling isolated in their struggles.
What is bed wetting?
Ferreirinha defines bedwetting as the unintentional urination during sleep after a child is typically expected to have bladder control, usually between the ages of five and seven.
Parents need to understand that this condition is not intentional.
“The child’s brain and bladder are still mastering communication during sleep, or they may be deep sleepers who don’t awaken even when their bladder is full,” he explained.
Medically, bedwetting is divided into two categories:
- Monosymptomatic enuresis: Night-time bed wetting only.
- Non-monosymptomatic enuresis: Includes both night and daytime symptoms.
Additionally, it can be classified into primary, where the child has never had a prolonged dry period, or secondary, where bedwetting returns after at least six months of dryness. Daytime wetting, while less common, is more likely to be associated with underlying medical problems needing attention.
What causes bed wetting?
Numerous factors can contribute to bedwetting, including:
- Delayed bladder maturity.
- Sleep disturbances.
- Hormonal imbalances, such as issues related to antidiuretic hormone (ADH), which usually reduces nighttime urine production.
- Overactive bladder, which causes unexpected contractions and urges.
- Genetic predisposition; children with a parent who wet the bed during childhood have a 50% chance of doing so themselves, which increases to around 75% if both parents experienced it.
Other possible causes include stress, constipation, urinary tract infections (UTIs), and rare neurological conditions that disrupt communication between the brain and bladder.
Understanding these factors can aid in alleviating the longstanding stigma surrounding this condition and enable parents to approach it from a place of knowledge.
The psychological effects
Beyond physical health, bedwetting can exert a significant psychological toll on children. This often manifests as feelings of embarrassment, shame and social anxiety.
Children may withdraw from social interactions, avoiding sleepovers or camping out of fear of being ridiculed.
“The worst thing a parent can do is punish or shame a child for bedwetting. It’s crucial to understand that the child isn’t doing this on purpose. Support, empathy and consistency go a long way in helping them feel safe and motivated.”
Management and treatment options
While many children eventually grow out of bedwetting, there are several effective management strategies for those who need assistance.
Ferreirinha advocates for a healthcare professional’s evaluation if bedwetting persists or leads to emotional distress.
Possible management strategies may include:
- Scheduled toilet breaks during the day and before bed.
- Avoiding caffeine, fizzy drinks and colourants.
- Creating a child-friendly toilet environment.
- Encouragement to use school toilets when necessary.
- Avoid waking or lifting the child at night.
- Maintaining the use of nappies until the child shows consistent dry nights.
In some cases, medication might be required.
Desmopressin, a synthetic version of ADH, can help reduce urine production overnight, while anticholinergic medications may be considered for children with an overactive bladder, although these are not typically a first-line treatment.
Interestingly, while bedwetting commonly resolves in childhood, about 1% of adults may continue to experience nocturnal enuresis, often linked to chronic medical or neurological issues.
The path forward
Ferreirinha says addressing bedwetting with compassion and understanding is crucial.
“Most children simply need time, reassurance, and support. The more we talk openly about bedwetting, the more we can destigmatise it and the better supported our children will be,” he added.
