For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, you can find advice on bedwetting for teenagers and young adults.

Bedwetting in teenagers and young adults

Bedwetting is a very common problem in children, but is less well known about in teenagers and young adults.  However, many in this age group find it not only embarrassing and distressing, but difficult to deal with.

What causes bedwetting in teenagers and young adults?

Bedwetting is caused by a combination of problems:

• Not being able to reduce the amount of urine that the kidneys produce overnight. A special chemical messenger, called vasopressin, usually gets released at night to tell the kidneys to make less urine than they do during the day. That is why most people can stay dry, even if they sleep for eight or more hours a night. If there is not enough vasopressin, then too much urine will be made during sleep.
• Not being able to hold onto all the urine that is made. This may be because the bladder is not big enough, or not working well enough. If the bladder is too small or gets ‘twitchy’ when it fills then it is more likely to empty overnight, even if the kidneys do reduce the amount of urine they make while the person is asleep
• The brain is unable to wake the person up, when the bladder signals that it needs to empty. Not being able to wake up to bladder signals is the main reason for wetting the bed. People who can wake up to go to the toilet will do so. It is the not being able to wake up that causes the wet bed.

Bedwetting is not your fault. it may be helpful to be aware that, not drinking enough during the day, fizzy drinks, drinks with caffeine in, eating salty or high protein foods just before going to sleep, forgetting to empty your bladder before going to sleep and being constipated, may cause bedwetting tor make it worse.

Why haven’t I grown out of bedwetting?

Some children do grow out of bedwetting. However, this is most likely to happen in younger children who are only wet on a few nights a week. Those who wet every night or most nights are least likely to just get better with time.  Although that does sometimes happen, it is not possible to predict who will just get better with no treatment and who will not.

Is there anything I can do to try and help the bedwetting get better?

There are a few things that you can do to help bedwetting improve. Although you may have already tried these with no success, that does not necessarily mean they will not help now.  So, if you are not already doing them, it is always worth trying to see if they do make any difference:

• Make sure you drink well during the day. Having enough water-based drinks will help your bladder to fill properly and stretch to the size that is should be. It will also help to prevent constipation, which can make bedwetting worse. Teenage girls should be drinking about 1 ½ – 2litres of water-based drinks a day and teenage boys should have about 2 – 2 ½litres per day. This should be divided equally into six to eight drinks with the last drink at least an hour before sleep.
• Avoid fizzy and caffeinated drinks, including energy drinks. These can irritate the bladder and cause it to need to become ‘twitchy’. This can make bedwetting worse.
• Avoid eating in the hour before bed. Particularly avoid salty foods and those that are high in protein. Salt and protein encourage the kidneys to make more urine than usual.
• Make sure you go to the toilet just before you settle to sleep.

I have tried all this and am still having wet nights – what else can I do?

If making changes to your lifestyle have not helped, then contact your healthcare professional and ask for an assessment and some treatment. The most common first-line treatments for bedwetting are an alarm or desmopressin. The alarm works by making a loud noise as soon as you start to wet. This is meant to wake you so that you can go to the toilet.  Over a few weeks most people learn to either sleep through the night without needing to wee, or they learn to wake before they are wet.  Desmopressin is a melt or tablet that tells your kidneys to make less urine while you are asleep and is very effective for some people.

About 40 – 60 % of people do not respond to just one treatment for bedwetting. They may need to use both the alarm and the Desmopressin at the same time. Some also need a medication to help their bladder to hold onto urine better. The medicines usually used are from a group called anticholinergics. Your healthcare professional should be able to discuss the most appropriate treatment(s) with you.

I have used these treatments when I was younger – they didn’t work then

Many teenagers and young people who have previously had treatment for bedwetting that did not work , or that did work but where the wetting started again later may feel frustrated, upset, anxious and as if they will always have this problem. However, as we grow up our bodies change. Therefore, treatments that did not work when you were younger may work well later.  Therefore, you should discuss options with your healthcare professional. You can also ask whether there is a local specialist service that you can be referred to.

Where can I find more information about bedwetting in teenagers?

Bladder & Bowel UK is a national charity. It provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

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The theme of International Youth Day 2019, which falls on 12th August each year, is ‘Transforming Education’.

It highlights efforts to make education more inclusive and accessible for young people. It is known that education has many benefits, one of which is better health. In the UK we are fortunate that all young people should have access to education. However, experiences of school and college can be negatively affected by health conditions, including bladder and bowel issues.

It is accepted that nearly a million children and young people in the UK have difficulties with their bladder and/or bowel. While a higher percentage of young children are affected, compared to teenagers and young adults, professionals feel that bladder and bowel problems are often not reported by teenagers. The true numbers affected are likely to be much higher.

There are many reasons why young people do not disclose a bladder or bowel problem.

These include feeling different at a time of life when fitting-in is very important. Embarrassment, shame, anxiety, not believing that anything can be done to help and sometimes previous attempts at treatment that have not worked are all factors as well. Occasionally young people have experienced punishment for having wetting or soiling ‘accidents’ making them feel the best course of action is to hide the problem. A lack of specialist services for young people with bladder and bowel difficulties in some parts of the UK does not help.

Bladder and bowel issues affect young people at school and therefore have an impact on their education. Toilet facilities are not always clean, or well-stocked. They may even feel unsafe for some young people.   Too often young people tell us that they are not allowed to use the toilet when they need to, causing anxiety and difficulty in concentrating on lessons. For those who have open access to the toilet, leaving the classroom during lessons several times a day, disrupts learning and may result in others asking questions the affected person would rather not answer.

Many adults are not aware that continence (bladder and bowel problems) affect young people. Teachers generally want to help support young people, but if they are unaware of the possibility of a problem, let alone that one or more of their students is trying to cope with an issue, they are unable to support.

What causes bladder and bowel problems in young people?

Some young people are born with bladder and/or bowel problems. They may need surgery or treatments in early childhood and may continue to need medical interventions, such as using catheters to drain their bladder, or bowel washouts to help them poo, into adulthood and beyond.

Other young people have not had problems until they were a few weeks, months or years old. Problems which develop when there is no underlying issue with the way the bladder or bowel are constructed are called ‘functional’ problems.  Functional problems include day and nighttime wetting, having to rush to the toilet, having to use the toilet frequently, having constipation or having soiling (poo leaking into the underwear). Functional problems are very common and can affect anyone, although they are more common in those with additional needs. With the right treatment most functional bladder and bowel issues can be cured or improved.

What can be done to help?

For young people who have a bladder and/or bowel issue, the first step is to speak to a trusted adult, visit your GP (family doctor) or speak to your school nurse. They may be able to offer some initial advice and should know who the best person is to speak to in your area.

What about school?

If you feel able to let a teacher at school know about the issues you are having with toileting, they may be able to help. Many secondary schools will provide a ‘medical’ or ‘time out’ card to students who need open access to the toilet. Discuss your needs with them. Disabled toilets or gender-neutral toilets should have bins in them for those who need to dispose of equipment such as catheters or pads.

If your school toilets are not of a good standard or do not provide all the facilities you need, then consider bringing this up with the school council. You could suggest a fund-raising scheme to help improve the toilets, or ask the senior school staff to work with you to get better cleaning and stocking of the toilets.

Where else can I get advice and information?

Bladder & Bowel UK is a national charity that is able to offer resources, advice and information to people of all ages who are affected by bladder and/or bowel issues and to those who support them.

Bladder & Bowel UK have lots of resources and information available on their website at www.bbuk.org.uk that are free to download and print. Bladder & Bowel UK also have a confidential helpline at email bladderandboweluk@disabledliving.co.uk or telephone 0161 214 4591.

This post has been written by Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK. To view similar posts please visit www.bbuk.org.uk/blog.

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Many bodily functions are considered private and not for discussion. Top of the list of the ‘not to be talked’ about is toileting! Many people think that once a child has toilet trained their bladders and bowels will work well for the rest of their lives. If they do have problems with wetting or soiling they will only happen when they get really old. This myth is able to continue because so many of us are too embarrassed to discuss problems, even with the people we are closest too. So those young people who do have a problem often don’t ask for help. Read on to discover some possible reasons for toileting troubles in teenagers.

What toileting problems may teenagers have?

Problems that teenagers may have with their bladder and bowels include:

• Frequency – having to go to the toilet for a pee more than seven times a day
• Urgency – having to get to the toilet in a hurry some or all of the time
• Wetting – when pee comes out on its own, usually with little or no warning
• Bedwetting – wetting during sleep. There may be other problems as well, or the bedwetting may just happen at night, with no pee or poo problems during the day.
• Constipation – having a poo less than three times a week; having poos that are painful or difficult to pass; passing poos that are very large, small, passing poos that are very sticky, or hard, or loose; having to strain to poo
• Soiling – when poo leaks into the underwear, either because it gives no warning it needs to come out or because you don’t know it is there

What can I do to make the problems better?

• Drink plenty of water based drinks, spaced evenly throughout the day (about 1 ½ – 2 litres per day for teenage girls and 2 – 2 ½ litres a day for teenage boys, with more if the weather is hot, or you are doing lots of exercise):
  This helps by making sure that pee remains weak (pale in colour) and so less likely to irritate the lining of your bladder, which makes wetting worse. Being well hydrated also helps to prevent constipation, which can cause problems with the bladder as well as the bowel. Drinking well also helps to prevent urinary tract infections (UTI).
• Avoid drinks that contain caffeine (tea, coffee, hot chocolate and energy drinks). These not only make the kidneys produce more wee, but also irritate the bladder and therefore may make wetting worse.
• Avoid drinking in the hour before bed, particularly if you have problems with bedwetting.
• Eat plenty of fruit and vegetables (five to seven portions a day). This helps prevent constipation.
• Go to the toilet as soon as you feel the need.
• Talk to someone about the problems (see below).

Can school help?

If you are having problems with your bladder or bowel, you should be able to get a medical pass to allow you out of lessons, so that you can go to the toilet as soon as you need to. Most schools will provide a pass if they are aware of the problem. You could ask your pastoral leader (e.g. head of house, or head of year) or ask your parent or carer to speak to them. You could ask your school nurse to arrange the pass for you.

If you are worried about the state of your school toilets, or if you have limited access to drinks at school, you and your friends could raise this as an issue with the school council.

What other help is there?

Some teenagers have toileting issues because of a medical condition they have been born with, or that has developed later, due to injury or illness. They may need to use catheters or medicines or to have special bowel management programmes. If this applies to you, then do follow the advice you have been given and if you are worried or struggling let your health care professional know.

Life for teenagers is difficult. There is a natural need to be or feel the same as everyone else. If you had experienced ‘leaks’ when you were younger and were told off for this, because the adults looking after you thought they were being lazy or naughty, then you may be particularly worried about asking for help. You should try not to be concerned about asking for help as there is now a better understanding of the causes of these problems.

At Bladder & Bowel UK we know that having a problem with your bladder and/or bowel (continence problems), causes distress to young people. Feeling the need to hide such problems makes young people feel different and cut off from friends and social groups. Continence problems, if discovered might result in teasing or bullying. They impact on self-esteem. They reduce opportunities of those affected such as avoiding school trips and sleepovers. In extreme cases they can cause symptoms of depression.

Where can I go for more help?

Treating bladder and bowel problems may be straightforward, but for some people takes time and effort for improvement. However, most can be treated. So if you or someone you know is affected do ask for help. School nurses run drop-in clinics in most secondary schools. Your school reception should be able to tell you when the nurse is going to be in school. You do not need to tell them why you want to see the nurse.

You can tell your parent or carer and ask them to make you an appointment to see your GP. If you are over 16 years old you can register with a GP and make an appointment on your own

If you would like to talk about toileting troubles in teenagers, you can contact the Bladder & Bowel UK helpline for free confidential advice by email at bladderandboweluk@disabledliving.co.uk or on the telephone 0161 214 4591.

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Bladder and bowel problems are common in people of all ages, but are rarely discussed. This increases embarrassment and anxiety and makes it more difficult for teenagers to ask for help. For some, wetting or dribbling of urine during the day, bedwetting, constipation and soiling (leakage of poo into the pants) has been a problem throughout their childhood. If this is the case, there can be a feeling that nothing can be done to help. 

We know that about 900 000 children and young people have problems with their bladder or bowel.

Some teenagers try very hard to hide their bladder and bowel problems from family and friends and some have been bullied because of their problems. This results in many feeling socially isolated, unhappy and many don’t seek help. One teenager described the problem in a new report published in March 2018 as “not life threatening, but life ruining”.

Is there anything I can do to help myself?

There are some things you can do that are good for you, but also might help the problem, although this can take time.

Drinking plenty of water based drinks helps by ensuring that urine (wee) remains dilute and pale. Concentrated urine irritates the lining of the bladder and makes wetting problems worse. Fizzy drinks and drinks that contain caffeine (tea, coffee, hot chocolate and energy drinks) also irritate the bladder and can make wetting worse, so should be avoided.  A good fluid intake can also help prevent wee infections (also known as urinary tract infections or UTI).

• Drinking well also helps poos to remain soft and prevents constipation. Constipation can cause bladder problems or make them worse.
• Teenage girls should be drinking about 1.5 – 2 litres of water based drinks per day. Boys should be having about 2- 2.5 litres per day.  If you are taking plenty of exercise or the weather is very hot, you should have more than this
• Eating plenty of fruit and vegetables is not only good for health, but helps prevent constipation.
• Going to the toilet as soon as you feel the need helps. You may need to ask your school nurse to help you arrange a toilet pass if your school does not let you go when you need to. Many schools use a ‘time out’ card or ‘medical pass’ so others will not find out about the problem.

Can anything else be done?

Bladder and bowel problems rarely get better on their own, but with the right treatment most can be helped and many can get completely better. The first step is to talk to a health care professional who understands the issues and knows the best route for accessing treatment locally. School nurses usually have a drop-in clinic at school, which teenagers can go to for confidential advice, support and referral on if required. The GP is another person who should be able to provide help and referral. If you don’t understand or are not clear, then don’t be afraid to ask lots of questions. It can help to write down a list of things you want answering before you go to see someone.

When you see a health care professional they may ask you lots of questions about your bladder and bowel and should then be able to explain the problem to you.  They should discuss the options with you, so that you are involved in decisions about which treatments to try.  Sometimes they may suggest something you have tried before and which did not work then.  However, we know that treatments can work that have not worked in the past, so try to keep an open mind.

Further information and getting in touch

Bladder & Bowel UK have developed a range of information leaflets about various continence problems and these are all available on our website. The leaflets are in our Children and Young People Resources section.

Bladder & Bowel UK also have a confidential helpline. For more information please send an email to: bladderandboweluk@disabledliving.co.uk or contact via telephone on: 0161 214 4591. Teenagers can get in touch themselves, or ask a parent or carer to do so on their behalf.

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