Bedwetting natural history, complications and prognosis
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Steven C. Campbell, M.D., Ph.D., [2] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic.
Complications
- Complications may develop if a physical cause of the disorder is overlooked.
- Psychosocial complications may arise if the problem is not dealt with effectively in a timely manner. A review of medical literature shows doctors consistently stressing that a bedwetting child is not at fault for the situation. Many medical studies state that the psychological impacts of bedwetting are more important than the physical considerations. “It is often the child's and family member's reaction to bedwetting that determines whether it is a problem or not.”[3]
- Studies show that bedwetting children are more likely to have behavioral problems. For children with developmental problems, both the behavioral problems and the bedwetting are frequently part of the developmental issues. For bedwetting children without other developmental issues, these behavioral issues can result from self-esteem issues and stress caused by the wetting.[4]
- Psycholgists report that the amount of psychological harm depends on whether the bedwetting harms self-esteem or development of social skills. Key factors are:[5]
- How much the bedwetting limits social activities like sleep-overs and campouts
- The degree of the social ostracism by peers
- Anger, punishment, and rejection by caregivers
- Psychological theory through the 1960s placed much greater focus on the possibility that a bedwetting child might be acting out, purposefully striking back against parents by soiling linens and bedding. More recent research and medical literature states that this is very rare.
- Medical literature states and studies show that punishing or shaming a child for bedwetting will frequently make the situation worse. Doctors describe a downward cycle where a child punished for bedwetting feels shame and a loss of self-confidence. This can cause increased bedwetting incidents, leading to more punishment/shaming, “an escalating cycle of wetting accidents and shame.” [6]
- In the United States, about 35% of enuretic children are punished for wetting the bed.[7] In Hong Kong, 57% of enuretic children are punished for wetting. [8]
- Parents with only a grade-school level education punish bed-wetting children at twice the rate of high school- and college-educated parents. [9]
- Parents and family members are frequently stressed by a child’s bedwetting. Soiled linens and clothing cause additional laundry. Wetting episodes can cause lost sleep if the child wakes and/or cries, waking the parents. A European study estimated that a family with a child who wets nightly will pay about $1,000 a year for additional laundry, extra sheets, disposable absorbent garments such as diapers, and mattress replacement. [10]
- Despite these stressful effects, doctors emphasize that parents should react patiently and supportively.[11]
- Bedwetting children feel effects ranging from feeling cold on waking, being teased by siblings, being punished by parents, and being afraid that friends will find out. Whether bedwetting causes low self-esteem remains a subject of debate, but several studies have found that self-esteem improved with management of the condition.[12]
- Children questioned in one study ranked bedwetting as the third most stressful life event, after parental divorce and parental fighting. Adolescents in the same study ranked bedwetting as tied for second with parental fighting.[13]
Prognosis
- The condition poses no threat to the health of the child if there is no physical cause of bedwetting.
- The child may feel embarrassment or have a loss of self-esteem because of the problem. It is important to reassure the child.Most children respond to some type of treatment.