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Impact of Bed Wetting

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Introduction to bed wetting

Bed wetting or enuresis is defined as intermittent episodes of wetting the bed while asleep in children over 5 years of age. Two types of bed wetting are described although there is often overlap between the two types. Monosymptomatic nocturnal enuresis (MNE) refers to bed wetting that occurs in children who have no other bladder problems and who do not wet themselves during the day. Non-monosymptomatic nocturnal enuresis (NMNE) refers to children who wet the bed at night and have additional daytime symptoms.

Studies which have looked at bed wetting have shown that it is a common disorder affecting 20% of 5 year olds, 10% of 10 year olds and 3% of 15 year olds. With no treatment, 14% of children who wet the bed will overcome this disorder each year. In a small percentage of people, however, bed wetting persists into adulthood where its consequences are even greater.

bed wetting is a distressing disorder that carries a significant burden. This disorder has psychological, social and financial implications for you, your child and your family. By identifying and treating bed wetting at an early age, it is hoped that its impact can be minimised.

 

For more information about what causes nocturnal enuresis and how it can be treated, see Nocturnal Enuresis (Bed Wetting).

 

Psychological impact of enuresis

It is well established that enuresis has a significant impact on self-esteem. Low self-esteem is thought to result from a combination of tension among families, social marginalisation and treatment failures. Half of children who wet their beds report being teased by their peers or siblings and feelings of bewilderment and humiliation are common. Children with day time symptoms experience greater distress and have lower self-esteem than those who wet at night only.

A study conducted in Sweden found that self-esteem in children who wet their bed was much lower than in children who did not wet. Another study of primary school aged children found that bed wetting ranked as the third most distressing out of a series of 11 critical life events. The only two events to rank above bed wetting were divorce and strident parental fighting with bed wetting ranking higher than being teased frequently by peers which ranked fourth.

Of greater concern is the fact that enuretic children may be at increased risk of physical and emotional abuse particularly where the family is dysfunctional. Children do not typically wet the bed on purpose and research has shown that punishing children for wetting the bed worsens self-esteem and exacerbates the problem.

A Hong Kong study looking at bed wetting in adults found that enuresis has significant psychological effects. Adults who wet their bed had higher rates of depression, lower self-esteem and significant problems with sleeping when compared to adults who didn’t wet the bed.

 

Social impact of enuresis

An English study which looked at the impact of bed wetting on children found that the social impact of bed wetting was most worrisome for these children. These children are less likely to participate in social activities including school camps, sleepovers and family holidays for fear of wetting the bed. Children who wet the bed may also worry that their bedroom smells of urine and therefore may be reluctant to invite friends over. This social isolation can have a negative impact on development.

In adults, bed wetting can affect choice of job, performance at work and participation in social activities. Making close friends and family interactions were least affected by enuresis in one study. Adult bed wetters are less likely to attend university when compared to adults who did not wet their beds.

 

Financial impact of enuresis

Bed wetting is also associated with significant financial costs. One study estimated that the cost associated with washing and drying bed linen was $1,000 USD per year.

 

Impact on parents

The impact of bed wetting on the parents of the child must also be considered. Research has shown that the greatest concern of parents of children who wet the bed is the impact on their child’s emotional and social development. In some circumstances, parents resort to punishment of the enuretic child, particularly in migrant populations. This has been shown to worsen self-esteem and exacerbate the bed wetting.

Bed wetting also creates an additional work load for parents in the form of washing and drying bed linen and this is associated with significant financial costs.

 

Summary

Bed wetting carries a significant burden for both the affected child and their family. Children who wet their bed have lower self-esteem, restrictions on social activities and are at risk of physical and emotional abuse. Adult bed wetters have higher rates of depression, lower self-esteem and the condition has a significant impact on education and career choices.

Early identification and treatment of this condition aims to minimise the impact of enuresis on the child and their family. Several treatment options are available including alarm therapy, desmopressin and other drugs which in the majority of cases successfully overcome this disorder.


Tools

My dryness tracker app

A free app for individuals being treated for bedwetting (nocturnal enuresis), or who plan to see a doctor about the condition. Features a bedwetting checklist, day-time and night-time voiding diaries, alarm therapy progress tracker, desmopressin progress tracker (restricted access), WetAlert® enuresis alarm ordering facility and treatment progress reports. Available from the App Store and Google play for use on smartphone and tablet.

 


Stephen’s experience with bed wetting

Stephen recalls his bed wetting days imageBed wetting is very treatable and there is help at hand. We spoke to Stephen about his experience growing up with bed wetting and how he eventually managed to overcome it. For more information, see Nocturnal Enuresis: Stephen recalls his bed wetting days.

References

  1. Neveus T, Von Gontard A, Hoebeke P et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation committee of the International Children’s Continence Society. The Journal of Urology. 2006; 176: 314-324. [Abstract] [Full Text]
  2. Bottomley G. Treating nocturnal enuresis in children in primary care. The Practitioner. 2011; 255: 23-26. [Abstract]
  3. Schulpen T. The burden of nocturnal enuresis. Acta Paediatrica. 1997; 86: 981-984. [Abstract]
  4. Norgaard J, Jurhuus D, Watanabe H. Experience and current status of research into the pathophysiology of nocturnal enuresis. British Journal of Urology. 1997; 79: 825-835. [Abstract] [Full Text]
  5. Keuhhas F, Djakovic N, Hohenfellner. Infantile enuresis: current state-of-the-art therapy and future trends. Reviews in Urology. 2011; 13: 1-5. [Abstract] [Full Text]
  6. Hagglof B, Andren O, Bergstrom E et al. Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Scand J Urol Nephrol. 1997; 183: 79-82. [Abstract]
  7. Van Tijen N, Messer A, Namdar Z. Perceived stress of nocturnal enuresis in childhood. British Journal of Urology. 1998; 81: 98-99. [Full Text]
  8. Yeung C, Sihoe J, Sit F. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. British Journal of Urology. 2004; 93: 341-345. [Abstract] [Full Text]
  9. Caldwell P, Edgar D, Hodson E et al. Bedwetting and toileting problems in children. Medical Journal of Australia. 2005; 182: 190-195. [Abstract] [Full Text]
  10. Butler R, Redfern E, Forsythe W. The child’s construing of nocturnal enuresis: a method of inquiry and prediction of outcome. Journal of Child Psychology. 1990; 31: 447-454. [Abstract]
  11. Warzak W. Psychosocial Implications of Nocturnal Enuresis. Clinical Pediatrics. 1993: 38-40. [Abstract]
  12. National Institute for Health and Clinical Excellence. NICE clinical guideline 111 – Nocturnal Enuresis: the management of bedwetting in children and young people. Issue date October 2010. Available from [URL Link]
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Dates

Posted On: 28 February, 2012
Modified On: 22 July, 2015

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