Bed-wetting (Nocturnal Enuresis) in Children | Kids Clinic Singapore


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(Last updated: 12 Apr)

Children with Nocturnal Enuresis

Bed-wetting in Children

Bed-wetting, also referred to as nocturnal enuresis, 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 (> 5 years of age), 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 are some common questions asked on bed-wetting.

What is Bed-wetting?

It is uncontrollable wetting while asleep in an otherwise healthy child beyond early childhood. Most bed-wetters seeking treatment in Singapore are:

  • 5 years or older with majority between 7 to 12 years old
  • Suffering from frequent bed-wetting of at least twice per week, the majority being almost every night
Frequent bed-wetting in children of school-going age requires treatment and further investigation

Does Bed-wetting in Children Require Treatment?

Yes, especially when the child is already of school-going age and the wetting is frequent. Studies have shown that constant bed-wetting 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 prevents the child from participating in healthy outdoor activities like overnight camping and travelling

In Singapore, it has been found that bed-wetters and their parents sought treatment for the following reasons:
  • Restricted activities involving overnight sleep outside home
  • Suffering from frequent bed-wetting of at least twice per week, the majority being almost every night

How Common is Bed-wetting in Children?

Actual incidence of bed-wetting is unknown in Singapore. However, it is believed to be quite common and there is an increasing number of parents seeking treatment for their children in recent years. Its occurrence in Singapore might be under-reported as it had been found that many children 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 Bed-wetting?

The exact cause or causes of bed-wetting are unknown. Various factors or causes that have been suggested include:

  • Hereditary cause i.e. Bed-wetting often runs in the family
  • Inability to wake up to void urine. Bed-wetters are known to be deep sleepers.
  • A delay in maturation of bladder control at night.
  • Bed-wetting tends to improve with time and the majority of sufferers will ultimately grow out of it. However, this may take years and a small percentage of them (1%) will continue bed-wetting 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 bed-wetting.
    This hormone is important for reducing urine production at night.

Is Bed-wetting Due to Psychological Problems?

No. Bed-wetting is involuntary and the child is actually helpless and has no control over wetting. In fact, punishing or blaming a child for bed-wetting may actually lead to psychological problems in a child.

How is Bed-wetting Treated?

For treatment of bed-wetting, consult a paediatrician who will obtain a proper history and perform a physical examination of your child to make sure that there are no medical illnesses in your child. Investigations such as urine/blood tests or ultrasound scan of the bladder/kidneys may be necessary in some cases. In the absence of medical illnesses, your child’s paediatrician may suggest certain measures e.g. no oral fluids 2 hours prior to bedtime, going to toilet before bedtime, avoidance of caffeinated drinks (which may increase urine output and also affect sleep), bed-wetting alarm, star chart for reward/encouragement on dry days etc. Medications are rarely required unless severe. For worried parents, you might be reassured that bed-wetting often improves with age.

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