Tackling bedwetting: ‘Don’t be afraid to talk about it’

Bedwetting, otherwise known as urinary incontinence or enuresis, is fairly common, often embarrassing and sometimes difficult to talk about. It is estimated that about 20 percent of boys and 17 percent of girls, ages 6 to 7 years old have some problem with daytime or nighttime wetting. Still, many kids are reluctant to talk about wetting with parents, friends and teachers. Parents themselves often have a hard time confronting the issue.

The Voiding Improvement Program (VIP) at Boston Children’s Hospital offers a comprehensive approach to bedwetting tailored to each child’s individual needs. “Our program is driven by highly skilled and compassionate nurses who understand both the physiologic and emotional issues surrounding urinary issues,” says Pamela Kelly, the program’s nurse director. Treatment may include biofeedback training, relaxation therapy such as guided therapy and behavioral therapy.

Kelly and VIP’s director, Dr. Carlos Estrada, offer five tips for managing your child’s wetting issues.


Open communication

Open communication is an important first step in addressing a wetting issue.

“Kids have a hard time talking about their wetting problems for one obvious reason: It’s embarrassing,” Estrada says. “And positive communication is essential to creating a feeling of comfort and a plan to deal with enuresis.” Over time, embarrassment can build. In fact, Estrada explains, for some boys and girls, urinary incontinence “becomes a focal point for a family, and the negative attention results in kids turning inward.”

Adding to the embarrassment are feelings of helplessness. Estrada says wetting the bed at home or having an accident at school or on the playground can trigger these feelings and cause kids to postpone voiding. “Holding too long can lead to an overactive bladder and possibly more serious problems.”


Don’t be afraid to talk about bedwetting

Parents can compound the problem by failing to discuss wetting with their children. Some fear they will further embarrass their child, so they ignore urinary issues, hoping they will go away.

What’s more, kids with wetting issues feel worse over time, so it’s important to talk about them early. “Tell your children the condition is common,” says Kelly. “It’s important for children to know that other children have similar issues but because of the “private nature” of wetting, it is not commonly discussed with their peers. Parents and children need to know that it’s not their fault — children are not trying to be wet.”


Talk to your pediatrician about enuresis

Estrada urges parents to “be proactive and bring up the problem with their pediatrician during a regular check-up.”

The Voiding Improvement Program is available at Boston Children’s Hospital locations in Boston, Peabody, Waltham and Weymouth.

A referral to a specialist often provides the time and expertise needed to focus on your child’s condition. “We devote 45 minutes to an hour to each new patient appointment,” he says. “A pediatrician may not have that much time to talk about the topic.”


Empower your child

Once the problem has been discussed and a treatment plan has been created, kids need to be thoroughly involved in the process. “Unless the child is fully engaged and motivated, they’re not going to do what’s necessary to overcome their problem.”


Things will get better

Kids need to know wetting can be solved, usually through noninvasive methods. Many children, Estrada says, are fearful that treatment for wetting could be painful or involve surgery. “We have a set of tools to help children fix their problem and put it behind them.”

Positive reinforcement is essential. At the VIP, when kids complete goals and hit milestones in their treatment, there are celebrations, certificates, even graduation ceremonies.

“Our program is diagnostic, goal-oriented and focused on positive reinforcement,” Kelly explains. “The vast majority of kids respond well to that, and they respond poorly to the opposite,” she says.

Turning a negative into a positive through shared goals and constant encouragement are the hallmarks of the VIP program. But ending a wetting problem starts with communication. As Estrada and Kelly say, “Don’t be afraid to talk about it.”

Learn more about the Boston Children’s Voiding Improvement Program (VIP).