Bedwetting in Children
Q.  What is bedwetting?
It is uncontrollable wetting while asleep in an otherwise healthy child beyond early childhood.
Most bedwetters seeking treatment in Singapore are:
  • Five years or older with the majority between seven to 12 years old.
  • Suffering from frequent bedwetting of at least twice per week with the majority being almost every night.
Q.  Is bedwetting a problem that needs therapy?
Yes, especially when the child is already at school going age and the wetting is frequent.
  • Studies have shown that constant bedwetting 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 pf embarrassment and deters the sufferer from healthy outdoor activities like overnight camping and travelling.
  • In Singapore, it has been found that bedwetters and their parents sought treatment for the followings reasons:
    • Restricted activities involving overnight sleep outside home.
    • Parental fatigue.
    • Disrupted sleep for the household.
    • Fear underlying disease.
Q.  How common is bedwetting?
Actual incidence of bedwetting is unknown in Singapore. However, it is believe to be quite common and there is an increasing number of cases seeking treatment in recent years.
  • Itís occurrence in Singapore might be under-reported as it had been found that many sufferers 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-old, 5% among 10-year-olds and 1% in the adult population.
Q.  What causes bedwetting?
The exact cause or causes are unknown. Various factors or causes that have been implicated include:
  • Hereditary cause. Bedwetting often runs in a family.
  • Inability to wake up to void urine. Bedwetters are known to be deep sleepers.
  • A delay in maturation of bladder control at night. Bedwetting tends to improve with time and the majority of sufferers will ultimately become dry but this may take years and a small percentage of them (1%) will continue bedwetting 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 bedwetting. This hormone is important for reducing urine production at night.
Q.  Is bedwetting due to psychological problems?
Absolutely Not.
  • Bedwetting is involuntary and the child is actually helpless and have no control over wetting.
  • In fact, punishing or blaming a child for bedwetting may actually lead to psychological problems in a child.
Q.  Is there underlying disease like kidney and bladder problems in bedwetting?
No. The vast majority of bedwetters are healthy with no underlying disease.
  • Only rarely is bedwetting associated with other diseases. When this occurs, it is almost always associated with symptoms like wetting in the day, pain on passing urine, fever, excessive thirst, large urine volume or failure to grow.
  • When bedwetting occurs in a child who has been dry for months, this may be due to an underlying urine infection or sometimes due to stressful conditions like a change of environment, change of school, etc.
Q.  Can bedwetting be treated?
Yes. With treatment, the majority of sufferers can become dry or improve significantly.
Although bedwetting can resolve spontaneously, if left alone, this may take several years. To date, there are two established treatment strategies that have claimed about 70-80% success rate: bedwetting alarm and a synthetic anti-diuretic hormone (ADH) that can concentrate and reduce urine production.
Q.  How does bedwetting alarm help?
  • Bedwetting alarm is a form of conditioning therapy. It comprises a urine sensitive pad formed by a series of flexible wires connected to an alarm unit. The detector pad is placed on the childís underwear when he goes to sleep. The moment a few drops of urine comes into contact with the pad, the alarm will be triggered, awaking the child who will then cease voiding, get out of bed and complete voiding in the toilet. Several nights of being awakened in this manner, results in the development of a conditioned response enabling the child to hold his urine even when this bladder is full.
  • Thus, it takes time to train the bladder. Results are often seen only after weeks of therapy.
  • This method is effective in 70%-80% of bedwetters but it requires high motivation and patience on the part of the bedwetters and their parents, as well as constant support
    from therapists.
Q.  Where can I get help?
You can seek advice and treatment from your family doctors.
  • You may also obtain advice and support from the Society of Continence (Singapore) or call its hotline telephone number at 6787 0337 for assistance.