Published on 29. November 2017

Bedwetting – no reason to shame

Nobody likes to talk about it. Yet it is not uncommon for children and teenagers to occasionally wet the bed. If it happens frequently, it can become a great burden – for the child as well as for its parents and the whole family.

In the following interview, Professor Bernd Tillig explains when bedwetting requires medical clarification, what kind of support helps the affected children, and how treatment can be provided. He is the head physician of the Clinic for Pediatric Surgery, Neonatal Surgery and Pediatric Urology at the Vivantes Neukölln Hospital as well as the director of the Vivantes MVZ Prenzlauer Berg.

Professor Tillig, is bedwetting a common problem?

In toddlers, wet diapers are completely and naturally accepted by us. In preschoolers and school-age children, however, bedwetting becomes a predominantly social problem for otherwise healthy children, because children who "still wet the bed" are quickly stigmatized. Yet this relatively common phenomenon has nothing to do with intelligence, education or even uncleanliness. Studies show that up to 30 percent of children still wet the bed relatively frequently at night by the time they start school: By age 7, up to 13 percent are affected, boys about twice as often as girls. About 5 percent of children still wet the bed at night by the age of 10. Only from the age of at least 5 years, when it occurs at least once a month for at least 3 months, can wetting during sleep, at night or during naps, be considered a disorder requiring treatment. However, the child's level of individual development must always be considered. It is primarily a matter of individually strongly varying delays in the maturation or the training of a very complex reflex process for the control of the bladder function and the excretion of fluids. This also includes perception in the subconscious, i.e. during sleep. It is comparable to a very complicated learning process.

How do you experience the children with their parents who come to you with the problem of bedwetting?

Very differently and mainly depending on the social pressure the child experiences from friends and educators in the childcare facility and in the family. However, most often bedwetting is associated with a sense of failure and lack of self-esteem. Children do not like to talk about it, are sad because they are ashamed and often burdened with feelings of guilt. Parents are usually very worried, also insecure and at a loss, fearing organic causes or believing they have done something wrong in their child's upbringing. These emotional and psychological consequences of this predominantly developmental phenomenon "enuresis" can be avoided by education, counseling and timely treatment.

How do you determine why the child is wetting the bed?

Psychological and psychosocial factors play only a minor role as causes of bedwetting; they are rather consequences and have a reinforcing effect. For treatment, it is crucial to rule out organic causes. If the child can control the bladder normally during the day, is already reliably dry, and has not had to be treated for any urinary tract infections, then an organic cause is unlikely. There is often a family history of urinary tract infections: the risk of recurrence is around 45 percent; if both parents had urinary tract infections as children, the risk is as high as almost 80 percent. To confirm this assessment, an organic cause can be reliably ruled out with simple examinations as basic diagnostics.

What treatment options are available?

Symptoms that occur during the day, such as an increased and sudden urge to urinate, sometimes with only a small amount of urine being emptied into the underpants, must always be treated first. Only if the children show normal bladder control during the day and have a proven adequate bladder capacity, the treatment of bedwetting can be successful. Initially, conservative, non-medication treatment options are used. An open discussion often already helps the children to overcome their feelings of guilt and to improve their self-esteem and psychological situation – essential prerequisites for successful treatment. Documenting wet or dry nights in a calendar is another step. Then drinking habits should be reviewed and possibly changed. In most cases, however, further, more intensive treatment measures are required according to the possible causes; which of these is suitable in each individual case must be decided on an individual basis.

What advice do you give to children and their parents?

If possible, parents should contact an appropriate specialist before the child starts school in order to receive advice and have organic causes ruled out. Bedwetting is not uncommon. It should not be understood as a disease, but as a developmental phenomenon, as a certain delay of a quite circumscribed development, which has nothing to do with intelligence. The children need understanding and attention, not blame and punishment. Treatment requires patience, and normal development and maturation are part of the treatment concept. The affected children and their parents should always take care of the "problem" together.

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