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Understanding teenage bedwetting: impact and treatments

Four teenagers in a park playing with a ball

Bedwetting, medically referred to as nocturnal enuresis, is commonly perceived as a concern exclusive to young children. However, this condition also affects a significant number of teenagers, impacting their self-esteem, social life and overall wellbeing. As teenagers strive for independence and social acceptance, managing bedwetting can present unique challenges that are often misunderstood or overlooked.


Addressing bedwetting during the teenage years is crucial, not only for the immediate benefits of dry nights but also for building long-term confidence and emotional resilience. At Pee Paediatric Services (PeePS), we specialise in supporting teenagers who face this issue. We understand the complexities of teenage bedwetting and offer a compassionate, expert approach to treatment that respects the sensitivity of this developmental stage. Our goal is to empower teenagers and their families by providing effective solutions and strategies to manage or resolve bedwetting, enhancing their quality of life and paving the way for a brighter, more confident future.


Understanding bedwetting in teenagers


Nighttime bedwetting is a condition where individuals unintentionally pass urine during sleep. For teenagers, this can manifest in two main forms: primary and secondary enuresis. Primary nocturnal enuresis indicates that a teenager has consistently wet the bed since early childhood without extended periods of dryness. Secondary enuresis refers to the onset of bedwetting after the individual has been dry for at least six months, often triggered by psychological stress or a medical condition.


While bedwetting is often associated with younger children, it's not uncommon among teenagers. Although the prevalence of enuresis decreases with age, around 5 per cent of 10-year-olds wet the bed and up to around 2 per cent of 19-year-olds still experience bedwetting*. With age, there is an increasing tendency towards more severe enuresis, with approximately 48 per cent of 19-year-old patients wetting the bed every night*. 


The impact of teenage bedwetting extends far beyond the physical inconvenience of managing a wet bed. It can profoundly affect a teenager's self-esteem and social interactions. The fear of embarrassment can lead to avoiding overnight stays with friends or trips that would otherwise be exciting opportunities for social growth. This withdrawal can stoke feelings of isolation and difference at a time when fitting in feels crucial.


Moreover, the anxiety and stress associated with potential accidents can make social situations like sleepovers, school trips or camps particularly daunting. Such stress not only impacts social life but can also interfere with academic performance and overall mental health. 


Causes of bedwetting in teenagers


Understanding the causes of nighttime bedwetting is crucial in addressing this sensitive issue effectively, especially during the teenage years. The reasons for bedwetting are varied and often interrelated, involving physiological factors, genetic predispositions and associated health conditions.


Physiological factors:


  1. Bladder capacity: Some teenagers may have a functionally smaller bladder that is not yet able to hold urine produced during the night.

  2. Hormonal influences: The body produces a hormone called antidiuretic hormone (ADH) that helps regulate the production of urine at night. Lower levels of ADH can lead to increased urine production while sleeping.

  3. Deep sleep patterns: Teenagers who are deep sleepers may not wake up when their bladder is full, leading to incidents of bedwetting.


Genetic links and family history:


Bedwetting can often run in families. If one or both parents experienced bedwetting as children or adolescents, their children are more likely to face similar challenges. Understanding this genetic link can help families approach the situation with more empathy and less stigma, recognising it as a common physiological trait rather than a behavioural issue.


Associated conditions:


Several medical conditions can either cause or exacerbate bedwetting in teenagers. These include:


  • Urinary tract infections (UTIs): These can irritate the bladder, increasing the urge to urinate more frequently or urgently, which can lead to nighttime accidents.

  • Diabetes: Both type 1 and type 2 diabetes can lead to higher urine production, which can overwhelm a teenager's bladder capacity during the night.

  • Neurological disorders: Conditions that affect the nerves, such as spina bifida or a spinal cord injury, can interfere with bladder control.


At PeePS, we take a comprehensive approach to diagnosing and treating teenage bedwetting by considering all possible causes. By understanding the root of the problem, whether physiological, genetic or related to other health conditions, we can tailor a treatment plan that addresses these factors effectively, offering relief and support to teenagers and their families.


Challenges specific to teenagers


Teenage years are a critical period for personal and social development and facing the issue of bedwetting can complicate this already challenging time. The unique challenges that teenage bedwetting brings are not just physical but deeply intertwined with social and emotional aspects.


Social stigma and its effects on mental health:


The social stigma associated with bedwetting can be profoundly damaging to a teenager's mental health. As peers begin to share experiences like sleepovers, teenagers who struggle with bedwetting might feel anxious and embarrassed, fearing judgement if others find out. This fear can lead to feelings of isolation, low self-esteem and in some cases, serious mental health challenges such as depression or anxiety.


Challenges in managing independence:


For many teenagers, growing independence is a key developmental milestone, whether it's participating in school trips or even living in boarding schools or with non-family members. Bedwetting can make navigating these rites of passage more difficult, as teenagers might worry about managing their condition in unfamiliar environments without their usual support. This can sometimes lead them to opt out of activities that are pivotal for their growth and social integration.


The impact on academic performance and extracurricular activities 


The stress and sleep disturbances caused by bedwetting can also affect academic performance. Teenagers may experience fatigue, making it hard to concentrate during school hours or to complete homework effectively. Additionally, the emotional distress associated with managing bedwetting can deter them from participating in extracurricular activities like sports, music or clubs, limiting opportunities to explore interests and form friendships.


Diagnosing bedwetting in teenagers


Recognising when to seek professional help for bedwetting is a crucial step towards finding effective solutions and support. Understanding the diagnostic process can also provide reassurance to teenagers and their families, ensuring they are informed and prepared for what to expect.


When to seek help:


It's important to consult a healthcare provider about bedwetting if:


  • The teenager has never been consistently dry at night.

  • There is a sudden onset of bedwetting after a long period of dryness.

  • Bedwetting is accompanied by other symptoms such as painful urination, unusual thirst, snoring or behavioural changes.

  • The teenager expresses distress or embarrassment and the condition affects their daily activities and self-esteem.


Diagnostic processes at PeePS


1. Initial assessment and patient history:


The first step in diagnosing bedwetting involves a detailed discussion about the teenager's medical history and the specifics of their condition. This includes understanding the frequency and timing of bedwetting incidents, any previous attempts at treatment and family history of similar issues. Gathering this information helps to tailor the diagnostic and treatment approach to each individual's needs.


2. Physical examination and tests:


  • Physical examination: A general physical exam to check for any signs of conditions that might be causing or contributing to bedwetting.

  • Urine tests: These tests help rule out infections or diabetes, which can cause or exacerbate bedwetting.

  • Ultrasound: This imaging test is used to examine the kidneys and bladder for any abnormalities that might be affecting bladder function.


Our approach to diagnosing teenage bedwetting is thorough and sensitive. By understanding the underlying causes and factors contributing to bedwetting, we can provide more effective, personalised treatment plans, helping teenagers regain confidence and enjoy a better quality of life.


Treatment options and management strategies


Effective management of teenage bedwetting involves a combination of treatment strategies tailored to meet individual needs. Our comprehensive approach includes both non-medical interventions and medical treatments, supported by emotional and psychological care.


Non-medical interventions:


Behavioural strategies:


  • Fluid management: Adjusting the intake of liquids, particularly in the evening, can help manage the amount of urine produced at night. This doesn't mean teenagers should drink less overall, but rather adjust the timing to reduce nighttime bladder filling.

  • Bladder training: This technique involves exercises that increase the bladder's capacity and improve the teenager's control over urination. Scheduled voiding during the day can also be practised to enhance bladder discipline.


Use of bedwetting alarms:


  • Bedwetting alarms are a highly effective treatment option that works by sensing moisture and sounding an alarm to wake the teenager. Over time, this can help train the teenager's brain to respond to the sensation of a full bladder before bedwetting occurs, promoting a pattern of waking up to use the bathroom during the night.


Medical treatments:


For severe cases of nocturnal enuresis, medication might be recommended as a course of action. This medication can help to reduce urine production during the night and is often prescribed when fluid management alone isn’t enough. Other medications can help relax the bladder muscle, increasing bladder capacity and reducing the urge to urinate.


Also, bladder muscle relaxants can be used to treat overactive bladder symptoms and can be particularly useful for teenagers whose bedwetting is linked to an inability to control bladder contractions.


The role of therapy and counselling


Addressing the emotional and psychological aspects of bedwetting is crucial. Therapy and counselling can provide a safe space for teenagers to express their feelings about bedwetting and cope with any associated stress, embarrassment or low self-esteem. This support not only helps in managing the condition but also in strengthening the teenager's overall emotional resilience. With the right support, most teenagers can effectively manage or completely resolve bedwetting, leading to improved self-confidence and quality of life.


Supporting teenagers with bedwetting: tips for parents and caregivers 


At PeePS, we recognise the importance of a supportive environment in managing teenage bedwetting. Parents and caregivers play a crucial role in providing both emotional and practical support. Here are some strategies to ensure that teenagers feel supported and understood:


Open communication:


  • Build an open and non-judgemental dialogue with your teenager about bedwetting. Encourage them to express their feelings and concerns and reassure them that you are there to support them and not to blame them.


Practical support:


  • Help manage the practical aspects of bedwetting such as protecting the mattress, managing laundry and discussing overnight solutions discreetly. This helps reduce stress and embarrassment for the teenager.

  • Consider the use of protective bedding and waterproof mattress covers to simplify cleaning and maintain hygiene.


Empowering the teenager:


  • Encourage independence by involving them in finding solutions, such as setting up the bedwetting alarm or managing fluid intake schedules. This empowerment can help improve their confidence and control over the situation.


Educational strategies to reduce stigma:


Education at home and school:


  • Educate family members about the nature of bedwetting – it’s a common condition and not a fault of the teenager. This can promote empathy and understanding within the family.

  • Work with school teachers or nurses to ensure they are equipped to handle situations discreetly if bedwetting affects school activities or trips.


Peer education:


  • Initiatives like health education sessions that discuss common adolescent issues including bedwetting can help normalise the condition. Understanding that it's a medical condition and not something to be mocked can significantly reduce bullying and isolation.


Support groups and resources:


  • Encourage participation in support groups where teenagers can meet others facing similar challenges. This can help them feel less isolated and more understood.

  • Provide access to resources and literature on bedwetting to both teenagers and their peers, which can demystify the condition and promote a more supportive environment.


By combining these emotional and practical support strategies with educational efforts to reduce stigma, parents and caregivers can play a pivotal role in helping teenagers navigate the challenges of bedwetting. 


No teenager should have to navigate the complexities of bedwetting alone. Early intervention can lead to successful management and even complete resolution of the condition, paving the way for increased self-esteem and improved social interactions. 


We encourage parents and caregivers not to delay seeking help. To make this first step as easy as possible, we offer a free 15-minute discovery call. This no-obligation conversation is an opportunity to learn how we can help your teenager move towards a happier, more confident future.





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