Destigmatising bed wetting

Children need patience, not punishment

Bed wetting is one of the most common, yet least talked-about, childhood conditions. For many families, it’s a quiet source of stress, shame and frustration. But it shouldn’t be. As Dr Andrew Ferreirinha, Paediatrician at Mediclinic Kloof, explains, nocturnal enuresis – as it is clinically known – is not a behavioural problem or a result of poor parenting. “Bed wetting is a normal developmental issue that many children will outgrow with time, support and, when necessary, medical intervention.”

Despite how common it is, bed wetting remains largely misunderstood. A South African study found that 16% of children aged between 5 and 10 wet the bed, with the condition occurring twice as often in boys than in girls. Yet even with numbers like these, many parents are reluctant to seek help due to the social stigma attached.

Understanding bed wetting

“Bed wetting is when a child unintentionally urinates during sleep after the age at which they would normally be expected to have bladder control – usually between five and seven years old,” says Dr Ferreirinha. “Important to understand is that it’s not something children do on purpose. Often, it’s because their brain and bladder are still learning to communicate during sleep, or because they are deep sleepers who don’t wake up when their bladder is full.”

The condition is medically divided in two main categories. (1) Monosymptomatic enuresis, which refers to night-time bed wetting only and (2) non-monosymptomatic enuresis, which includes both night and daytime symptoms. It can also be classified as primary (the child has never had a prolonged dry period) or secondary (bed wetting returns after at least six months of dryness).

Daytime wetting is less common and more likely to be linked to underlying medical issues. “In cases where children are also having accidents during the day, it’s especially important to investigate further,” adds Dr Ferreirinha.

Why does it happen?

There are many possible reasons for bed wetting, including delayed bladder maturity, sleep disturbances, and hormonal imbalances.

“A common cause is an overactive bladder, where the bladder contracts without warning, making it difficult for the child to hold their urine,” says Dr Ferreirinha. “Another is the hormone ADH, which normally reduces urine production at night. If this hormone isn’t working as expected, the child may simply produce too much urine while asleep.”

Other contributing factors include stress, constipation, urinary tract infections (UTIs), anatomical abnormalities, and – more rarely – neurological conditions that interfere with the signalling between the brain and bladder.

“There is also a strong genetic component,” says Dr Ferreirinha. “If one parent wet the bed as a child, their child has about a 50% chance of also experiencing it. If both parents had the condition, the risk increases to around 75%.”

The psychological toll

As bed wetting is poorly understood and socially taboo, it often has psychological consequences that go beyond the physical. Children may feel embarrassed or ashamed, leading to low self-esteem, anxiety and even social withdrawal – particularly if they avoid sleepovers or camps out of fear.

“The worst thing a parent can do is punish or shame a child for bed wetting,” says Dr Ferreirinha. “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.”

Is there a cure?

While most children eventually outgrow bed wetting, Dr Ferreirinha says there are several management options to help the process along – starting with a visit to a healthcare professional.

“If bed wetting persists or causes distress, we can do some basic investigations to rule out underlying health issues,” he says. “If nothing medical is found, we look at lifestyle strategies and behaviour modification methods like reward charts.”

Additional non-pharmacological methods can also include:

• Scheduled toilet breaks during the day and before bed.
• Avoiding caffeine, fizzy drinks and colourants.
• Creating a comfortable and child-appropriate toilet environment.
• Encouraging children to use school toilets when needed.
• Avoiding lifting or waking the child at night.
• Not removing nappies until dry nights are consistent.

Some cases, however, may also benefit from the use of medication. The most common is desmopressin (DDAVP), a synthetic version of the antidiuretic hormone that reduces urine production overnight. For children with an overactive bladder, anticholinergic medications may also be considered, although these are not used as first-line treatment.

While most children grow out of the condition, Dr Ferreirinha notes that around 1% of adults may still experience nocturnal enuresis. “These cases are rare, and often linked to chronic medical or neurological issues,” he says.

Time, not punishment, is the answer

Ultimately, bed wetting deserves the same attention and compassion as any other childhood condition. “Most children simply need time, reassurance and a bit of help along the way,” says Dr Ferreirinha. “The more we talk openly about bed wetting, the more we can destigmatise it – and the better supported our children will be,” he concludes.