Adolescence is a sensitive time for young people. Teenagers who wet the bed can have particular difficulties forming close relationships and may avoid certain social situations. An effective treatment plan can be life-changing.
Although the prevalence of enuresis decreases with age, around 5% of 10 year-olds wet the bed,1 and up to around 2% of 19 year-olds still experience bedwetting.2 With age, there is an increasing tendency towards more severe enuresis, with approximately 48% of 19 year-old patients wetting the bed every night.2 The likelihood of spontaneous resolution decreases in those who are wet most or every night.
Impact of bedwetting on teenagers
As children grow older, more social situations that are problematic with enuresis are likely to arise (e.g. nights away from home, romantic relationships) and the stigma attached to bedwetting may feel more significant as patients go through puberty and adolescence. Social problems associated with bedwetting may become more acute and concerns for the future may play on patients’ minds, as reflected in patients’ quotes below. Research shows that adolescents who wet the bed have significantly higher scores on social anxiety compared with controls, including fear of negative evaluation, general social avoidance and distress, and social avoidance and distress in new situations.3
For parents of teenagers who wet the bed, there may be growing frustration about the laundering and practical tasks involved in dealing with bedwetting, particularly if the young person is reluctant to help with these tasks, despite being perceived as capable of doing so.4
Quotations from teenage patients
“My boyfriend has no clue. My best friends have no idea that I have this underlying secret that affects my life in so many ways. They have no clue. So I think “if I get married I might [wet the bed]” and obviously married people share a bed. That’s not news to anyone. So I’m like, “what am I going to do?” He might not want me there. He might kick me into the other room.”
Female, age 175
“. . .kind of feeling like an outsider, I suppose, feeling that you’re not normal if that makes sense.”
Male, age 195
“No. I couldn’t [talk to my friends about wetting the bed]. I don’t know, I just couldn’t. I know they’re my best friends and I’ve been friends with them since I started high school and they have come to me about things that they have, but I just couldn’t bring myself because people still laugh about wetting the bed. It’s still a topic of “Ha-ha! Do you wet the bed or something?”
Female, age 17 (night wetting and daytime urgency)5
“It’s the sheer fact that I have to lie constantly and I’m hiding. I feel like it’s a huge secret because let’s say, well explain, if I had to tell my friends “I wet the bed,” they’d be like “That’s why you did this. That’s why you had this excuse and that’s why you didn’t go there” and for people, everything would click into place. So I always feel a bit guilty lying.”
Female, age 175
“There’s a lot of things that I want to do, like staying overnight on school trips. And as much as that was sometimes possible with a lot of kind of careful planning, there were lots of times where, you know, I would just say “No I can’t go,” but not really, and I always felt like I was having to think up excuses and think up reasons why I couldn’t go to something.”
Male, age 195
“I had it until I was 16. It wasn’t easy every day!”
Male, age 18 (source: Ferring France)
“I’ve been wetting my bed since I was very small, and I’m telling myself it will stop one day but it’s very difficult to not give up”.
Patient, age 13 (source: Ferring France)
Treatment of teenage patients
Those still bedwetting in their teenage years tend to have more frequent bedwetting and a low probability of the condition resolving without proactive management.2 Given the emotional and physical challenges that occur in adolescence, bedwetting can be a highly distressing problem for these young people at a sensitive time. Some may have sought treatment for the condition previously without success, others may have been too embarrassed to seek treatment, or they and their parents may have been unaware that effective treatments are available. It is important for health professionals to assess each individual and their circumstances carefully, and to choose the most appropriate treatment plan.6 It is also paramount that professionals make provision to follow up these patients closely to monitor treatment efficacy and patient wellbeing. Establishing a rapport and trust is key to engaging the young person in their treatment decisions and increases treatment compliance and hence likelihood of success.
Quotations from Healthcare Professionals
Dealing with bedwetting can have a devastating impact on a child’s learning, development and well-being. It doesn’t help that bladder problems aren’t something young people find easy to open up to their friends about for fear of being laughed at and even bullied. This means teenagers are likely to keep their problem to themselves and are at risk of withdrawing from fun social activities such as sleepovers and trips away. We want teenagers and their families to know that help is out there and they’re not alone. Bedwetting doesn’t have to mean missing out on all the same things as your friends are doing.
ERIC, The Children’s Bowel & Bladder Charity UK
“As a bladder specialist, it is always wonderful for me to witness the blossoming of confidence and the emergence of personality in a young person who’s been successfully treated for bedwetting.”
Dr Anne Wright, Paediatric Bladder and Bowel Consultant UK
“Working with teenagers affected by bedwetting can be particularly rewarding. One young person who became dry wrote ‘thank you for giving me back my life’.”
Davina Richardson, Specialist Nurse UK
“Bedwetting is particularly difficult for teenagers. Not only is it a largely hidden problem that is embarrassing and distressing for them, but they have usually had a lifetime with this and many believe that there is no treatment and it is something they will always have to deal with. World bedwetting week is an opportunity for us to break the taboo and start to talk about this common medical condition and raise awareness that treatment is available.”
Bladder & Bowel UK UK
“For many patients, enuresis and its associated distress are unnecessarily prolonged despite being prescribed a potentially effective treatment – we must work to ensure best practice in evaluation of patients and in the use of each treatment”
Prof Johan Vande Valle, Paediatric Nephrologist Belgium
“Enuresis seems to be an often underestimated condition in terms of the suffering that children and their families have to go through, but there are efficacious therapy options once a correct and full diagnosis is made.”
Prof Serdar Tekgül, Paediatric Urologist Turkey
“Research shows that bedwetting is influenced by a number of risk genes. Families need to understand that enuresis is nobody’s fault, and is not necessarily a condition that resolves by itself. They should take an active role in seeking treatment”
Prof Søren Rittig, Paediatric and Adolescent Medicine Denmark
References
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Yeung CK, Sreedhar B, Sihoe JDY, Sit FKY, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int. 2006;97(5):1069-1073. doi:10.1111/j.1464-410X.2006.06074.x
Eray Ş, Tekcan D, Baran Y. More anxious or more shy? Examining the social anxiety levels of adolescents with primary enuresis nocturna: a controlled study. J Pediatr Urol. 2019;15(4):343.e1-343.e5. doi:10.1016/j.jpurol.2019.04.002
Morison MJ. Living with a young person who wets the bed: the families’ experience. Br J Nurs. 2000;9(9):572-574, 576, 578 passim. doi:10.12968/bjon.2000.9.9.6294
Whale K, Cramer H, Joinson C. Left behind and left out: The impact of the school environment on young people with continence problems. Br J Health Psychol. 2018;23(2):253-277. doi:10.1111/bjhp.12284
Haig M. Bedwetting in teenage girls. Women’s Health Medicine. 2005;2(6):44-45. doi:10.1383/wohm.2005.2.6.44
Hjälmås K et al. Nocturnal Enuresis: An International Evidence Based Management Strategy. J Urol 2004; 171:2545–2561.
Vande Walle J et al. Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2012; 171:971–983.
Theunis M et al. Self-Image and Performance in Children with Nocturnal Enuresis. Eur Urol 2002; 41:660–667.
Joinson C et al. A United Kingdom population-based study of intellectual capacities in children with and without soiling, daytime wetting, and bed-wetting. Pediatrics. 2007; 120:e308-16.
Nathan D. Nocturnal enuresis guidelines. Nottingham Children’s Hospital. 2014. 1–17.
Austin P et al. The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children’s Continence Society, The Journal of Urology. 2014; 191:1863–1865.
Nevéus T. Nocturnal enuresis – theoretic background and practical guidelines. Pediatr Nephrol 2011; 26:1207–1214.
The World Bedwetting Week Steering Committee brings together experts from across the globe to support this initiative and consists of representatives from the International Children’s Continence Society (ICCS), the European Society of Paediatric Urology (ESPU), the Asia Pacific Association of Paediatric Urology (APAPU), the International Paediatric Nephrology Association (IPNA), the European Society of Paediatric Nephrology (ESPN), the Sociedad Iberoamericana de Urologia Paediatrica (SIUP), the North American Paediatric Urology Societies, ERIC (The Children’s Bowel & Bladder Charity) and Bladder & Bowel UK.
