Bedwetting - common questions answered
If your child is still having 'little accidents' in the middle of the night you may be relieved to know that you're not alone. In fact, it's more common than you think with one in six children aged five wetting the bed two or more times a week.
Despite being as widespread as eczema or asthma, affecting nearly 800,000 children across the UK, bedwetting is still one of those taboo subjects which people don't talk about. In fact it's a very natural stage in your child's journey and something neither you nor your child should be embarrassed about.
If your child has recently wet the bed, you'll have plenty of questions. DryNites expert Dr Penny Dobson MBE is one of the leading experts on bedwetting, as founder and former director of ERIC, the UK charity for bedwetting. Here, Penny answers some of the most frequent questions asked by parents.
"Some children sail through toilet training. Others, quite naturally, take longer. Staying dry overnight is often the last part of the jigsaw puzzle, and is something that should resolve itself in time, but many children need a little help along the way."
What is bedwetting?
Sometimes called nocturnal enuresis, bedwetting is defined as the 'involuntary wetting during sleep', that is without any physical defect of the bladder or urinary system.
The term 'involuntary' is key here, as it means that children have no control over the wetting, so it is not the child's fault in any way.
The majority of children have something called 'primary bedwetting'. These children have never had a lengthy period of being dry at night (beyond the age of 5 years). Some children have what is called 'secondary bedwetting', when they start wetting having been dry for at least 6 months. The only difference between the two is that 'secondary bedwetting' is more likely to be triggered by a stressful event – such as starting a new school, or a new child in the family. Sometimes the bedwetting continues, despite the stress being resolved.
Almost twice as many boys as girls are late in becoming dry at night, but it is not clear why this is so. It may be simply that girls are generally more advanced in certain developmental areas.
What causes bedwetting?
More is known now about what causes bedwetting, thanks to recent research, but still more research is needed to gain a fuller picture. We do know that there are a number of physical factors which may be significant:-
• Children who wet the bed have difficulty in recognising the sensation of a full bladder at night, so they don't wake up or 'hold-on' to the sensation of a full bladder
• Some children aren't yet producing enough of the natural body hormone called vasopressin at night. Vasopressin works by 'putting the kidneys to sleep' so that less urine is produced overnight. Children whose vasopressin levels aren't yet developed have to cope with large volumes of urine at night – difficult at the best of times, particularly if the child does not easily wake up to the sensation of a full bladder.
• For a few children their bladder is a bit 'overactive' or 'twitchy', so it gives the sensation of fullness before it is really full. Many – but not all – of these children will have symptoms during the day, such as when they have to rush to the toilet, or go more often than usual.
It's also worth keeping in mind that there is a strong link between bedwetting and constipation, and that a urinary tract infection could also trigger a bedwetting episode. There is also a hereditary link; if both parents bed the bed, their child has a 77% chance of also being late; in the case of one parent the figure is 43%.
What can I do to help my child?
It is important to reassure your child that there are many other children with this problem - and it is not their fault. Talking it over and exploring how your child feels about the bedwetting and what he or she thinks about the situation might help find a way forward. There are also some straightforward things that you can try:
• Make sure that your child is drinking sufficient fluids during the day (6-8 glasses spread throughout the day is best). If you want to increase fluids do this gradually over a week or so. Try to avoid sweet or fizzy drinks, as these may contribute to the problem. You could cut out the last drink before bed – but of course ensure that your child does not feel thirsty as a result.
• Ensure that your child is not constipated.
• Make sure that your child empties his or her bladder before going to bed and can get to the toilet easily at night. A night light or torch may help if your child is afraid of the dark. Sometimes a potty in the bedroom works best.
• Encourage your child to go to the toilet regularly during the day (for example at breaktimes during the school day). If there are problems with the school toilets contact the Bog Standard Campaign www.bog-standard.org
• Use 'lifting' your child at night as a temporary measure only – and if you lift make sure that your child is fully awake (otherwise you're training children to empty their bladder in their sleep!)
Think about keeping a diary of your child's night-time wetting for a week or two, as this will help you to keep track of how things are going and what's having an effect. For instance, is anything different that they eat or drink on the nights they wet the bed? Do they wet the bed more frequently if they have a cold or are upset about something? Is there a relationship between not emptying their bowels before bed and subsequent bedwetting?
When should I get help?
There are different levels of seeking help, ranging from asking other mothers, to taking your child to an enuresis (sometimes called a pediatric continence) clinic. The more you know, the better equipped you're going to be to handle the situation.
If the bedwetting persists beyond the age of 5 years and you or your child are concerned, or your child suddenly starts bedwetting, you can speak to your GP, health visitor or school nurse. There should be a pediatric continence or enuresis clinic in your area. You can find out more by ringing the ERIC Helpline 0845 370 8008 (weekdays 10-4) or by logging on to the ERIC website www.eric.org.uk
There are treatment approaches that are very effective. For example the enuresis alarm or buzzer which helps the child to make the connection between the sensation of a full bladder and 'waking up' or 'holding on'. There is also a medication called desmopressin, which can be helpful for short trips away or as a longer treatment method.