Bedwetting - Nocturnal Enuresis

Thousands of Children in New Zealand wake in the morning to a wet bed. Wetting the bed at night (nocturnal enuresis) is very common in young children.
It affects approximately...

• 15% of 5-year-olds

• 5% of 10-year-olds

• 2% of 15-year-olds

• 1% of adults

Your child is likely to have 2 -3 other children in his or her class who also wets the bed!
Bedwetting occurs slightly more in boys than girls and some children wet their pants during the day.
Bedwetting is not considered to be a problem until children are about 7 years of age. That is a good time to introduce treatment programmes if the child wants to do something about it.
Almost all children grow out of bedwetting. About 1% of adults may still have occasional problems.
Bed-wetting can create problems of poor self-esteem, family stress and social isolation. The distress and disability of bed-wetting increases as the child gets older and many can be helped to become dry earlier.

Types of bedwetting

There are two types of bedwetting:

• children who have never been dry for more than a few months at a time have "primary" enuresis.

• children who have been completely dry for more than 6 months and then start wetting the bed again have "secondary" enuresis.

What causes bedwetting?

There is no universal cause of bedwetting but:

• Bedwetting runs in families

• If one parent was a bedwetter there is a 44% chance of the child bedwetting. If both parents were bedwetters the risk is 77%.

• The waking response to a full bladder is not fully developed, they have no conscious control over bedwetting.

• The bladder can't hold the amount of urine produced when asleep. Some children produce more urine than average overnight.

• The bladder may be twitchy or "overactive"- this may lead to wet pants or urgency even in the daytime.

• Restricting Fluid at night does not stop bedwetting.

• Constipation can lead to bedwetting.

• Bedwetting is rarely due to urine infection, disease or child abuse.

• Psychological problems are usually the result rather than the cause of bedwetting.

What can I do to help?

• Be patient and understanding - reassure your child, especially if they are upset.

• Keeping a record will show progress.

• Praise and reward your child for staying dry or getting up to toilet

• Respond gently if your child wets the bed even if you feel angry.

• Prepare the bed and the child - Protect the mattress with a funky Brolly Sheet, absorbent pads or towels and a heavy plastic cover and the child with extra-thick underwear and pajamas. Merino PJs or thermals can stay warm even if wet.

• Give the child plenty of fluid during the day.

• Avoid caffeinated drinks eg tea chocolate and fizzy drinks before bedtime

• Have the child urinate before bedtime.

• If you get your child up to urinate after being asleep for several hours make sure they are fully awake.

• Shower or bath in the morning before they go to school. The smell of urine may embarrass your child and lead to teasing.

Don't

• Don't punish the child for what he can't control.

• Don't use diapers or plastic pants if the child is over four or is embarrassed.

What tests are needed?

• lab tests on blood and urine, may be performed to rule out any medical conditions.

• scans or x-rays are not usually needed unless there is daytime wetting

How is bedwetting treated?

There are several ways to treat enuresis and your child can help decide what is best at this time. Some things that did not work before may work when repeated:

• Children under 7 may not see any need to do anything yet - most children grow out of wetting the bed, and you may be better to manage the wetting in the meantime. For example, enable your child to take care of a wet bed in the night themself and reward them for helping with a sticker chart.

• Alarms that awaken a sleeping child if wet are a good long-term treatment.

• Eventually the alarm trains the child to wake up before urination occurs. Alarms have a 70% success rate and work better with professional support and if children are keen.

• The doctor may give your child medicine for overnight stays and school camps. The medicine does not cure bedwetting.

• Treatment of Constipation will stop bedwetting in some children.

• A behaviour modification program may be given

• Waking up the child to go to the bathroom during the night can help but watch that your child does not miss too much sleep.

• Your child may be referred to a pediatrician (child health specialist) or urologist (a doctor specially trained in conditions of the bladder and urinary system)

• If a psychological problem is suspected, the child may be referred for help in this area

Remember...

• Bedwetting happens during sleep

• Children can't decide not to do it

• Be patient

• Most children grow out of it

Where can I get more information

If you would like more information about bedwetting you may find the following websites useful:

The New Zealand Continence Association (NZCA)
www.continence.org.nz/bedwetting
Phone: 0800 650 659
Email: jan@continence.org.nz

Provides a range of information and links to other New Zealand information. The website has database for bed alarm service by region.

www.keea.org.nz
Phone: 0800 KEEA NZ (0800 533 269)
Email: keea@xtra.co.nz

Our thanks to the Bedwetting experts at The Continence Assn for this excellent information

Where to from here?