Bedwetting is not caused by children being young for their age, being rebellious or drinking too much water after dinner. So why does it happen then?
Bedwetting (Nocturnal Enuresis) is when child empties bladder while sleeping, when the child should be old enough to control the bladder. It is one of the most common of all childhood problems and affects around 19% of school aged children. Each year 15% of children grow out of the bedwetting problem, but some continue to bed-wet into adulthood. The bedwetting rate in adults is 0.5% to 2.3%.
To have a better idea, in a class of 30 children:
- Aged 5: 5 wet the bed at least twice a week
- Aged 7 years: 2 wet the bed at least twice a week
- Aged 12 years: 1 wets the bed at least twice a week
- Aged 15 years: 1 child in every two classes wets the bed least twice a week
Bedwetting is caused by a mix of three things:
1. Difficulty to wake up from sleep
Some children find it hard to wake up when the bladder is full. The brain and the bladder don’t communicate properly, so when the child is asleep the brain doesn’t get the message that the full bladder needs to empty.
2. An overactive bladder
If the bladder is overactive, the bladder muscle becomes twitchy and can only hold a small amount of urine. A twitchy bladder therefore may spontaneously contract during sleep, which can result in wetting.
3. Polyuria (excessive urine) at night
Children who wet the bed may have a low level of a naturally occurring substance called vasopressin. The brain normally produces vasopressin during the night to reduce the amount of urine produced and allow an uninterrupted night sleep. If the child has low levels of vasopressin at night, they may produce more urine than their bladder can hold and if they do not wake up, they wet the bed.
There are few risk factors associated with bedwetting which make the child more prone to have bedwetting like Constipation, ADHD, sleep problems such as insomnia and sleep apnoea, urinary tract infections, epilepsy, and diabetes insipidus or mellitus.
The important thing for parents to know is that bedwetting is not caused by children being young for their age; laziness; bad behaviour; being naughty; rebelliousness; and drinking water after dinner.
If not treated, bedwetting can have long term implications like low self-esteem, feeling of inadequacy and self-consciousness, and a strong feeling of shame, failure and guilt. The child may find it hard to make friends; may be an underachiever at school, and parents may see behaviour changes such as depression or bad behaviour. Bedwetting can have a negative impact on the child’s emotional and social development, and the child may miss out on the fun things like school camps and sleep overs.
You should seek a paediatrician’s help when…
- The child is 6 years or older, and still bedwetting
- The child who has been dry for more than 6 months and suddenly starts wetting at night (at any age)
- The bed wetting makes child upset or angry
- The child wants to become dry
What parents can do to help the child
- Talk to your child about what has caused the problem and how their body works
- Ensure your child drinks 5-6 glasses of water daily
- Try to cut back fizzy drinks intake of your child
- Watch for constipation as this can make bladder problem worse
- Support your child in choosing to become dry and be positive about the treatments they are using
What parents should not do
- DO NOT punish the child.
- DO NOT shame the child in front of friends or family.
- DO NOT lift the child at night to toilet them. This may cut down on some wet beds, but it does not help the child learn to be dry.
- DO NOT try to fix bedwetting when other family members are going through a stressful time.
How is bedwetting is treated?
• Bladder training programs teach the child good bladder habits. This means that the child learns to stay hydrated and to empty their bladder well when they need to go to the toilet. This cuts down sudden urges that may cause wetting. Learning to hold lots of urine through the day does not always help dry nights.
• Bells and alarms work by teaching the child to wake up to the feeling of a full bladder. The alarm is used either on the bed or in the child’s underpants. The results are best when the child wants to be dry, wets very often, has help from a parent through the night, and uses the alarm every night for several months. Some children become dry using an alarm but later start to wet again. Alarms can work again after this relapse.
The bell and pad alarm system is available for rent from Western Specialist centre. It is research proved most effective treatment for bed wetting, if used properly and under a paediatrician’s supervision. The system is a safe and non-invasive treatment for children from 6 years to 18 years of age. It is more cost effective than spending money on nappies and pull-ups. Treatment with bell and pad takes approximately 6-8 weeks.
The idea of this machine is to condition the child to wake when they want to pass urine. When the child begins to wet a bell rings and the child wakes. Because the feeling of a full bladder and the sound of the bell happen at the same time, the child’s mind associates one with the other. Eventually the child wakes up when they feel the need to pass urine.
• Medications that change how active the bladder is or cut down how much urine is made through the night can be prescribed by a paediatrician. These drugs can be used to help the bladder work better at night. Drugs alone don’t often cure bed-wetting. Bladder function must be improved or bed-wetting may come back when the drug is stopped.
• Nappies, pull-ups or disposable pants do not treat the basic cause of bedwetting. They just keep the bed dry rather than keeping a child dry.
The writer is a senior paediatrician at Sunshine Hospital and Mercy Hospital, as well as Director, Western Specialist Centre (www.westernspecialistcentre.com.au)
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