Bedwetting in children with disabilities and additional needs
You Time To Take Action: World Bedwetting Day 2021
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 in children with disabilities.
What is bedwetting?
Bedwetting is a common childhood problem. It can affect any child. Bedwetting (sometimes called Nocturnal Enuresis) has a number of different causes. Staying dry at night requires a fine balance between how much urine is produced during sleep and the ability of the bladder to hold all of the urine produced. If the bladder gets full before morning the child has to be able to wake up to the bladder signals, get up and go to the toilet. A problem in one or more of those areas can result in the child wetting the bed.
Most children manage to sleep through the night without needing to wake up and pass urine. This is because they are able to reduce the amount of urine that the kidneys make when they are asleep and their bladders are big enough and work well enough to hold all the wee they do make.
How does bedwetting affect children who have a disability?
Having a learning disability, a physical disability or additional needs does not in itself cause bedwetting. However, bedwetting in children with disabilities affects large numbers of families, and treatment can help to make it better.
Children aged 5 years and older who have a disability, or additional need, who are toilet trained during the day, and who are still wet at night should always be offered help. Assessments and treatments for bedwetting are available and it is important to understand that children are not able to learn to be dry when they are asleep, in the same way that they learn to use the toilet in the day.
What causes bedwetting in children?
For some children, their bladder is not big enough to hold all the urine they make when they are asleep. Others have a bladder that is big enough, but it gets ‘twitchy’ and empties before it is full. Some children are not able to make enough of a chemical messenger called vasopressin. Vasopressin tells the kidneys to make less wee at night. If the child is not making enough vasopressin, their kidneys will make much more urine at night than they should, so the bladder will not be able to hold it all. If they are not able to wake up when their bladder is full, it will empty and the bed will be wet.
Another contributory factor is having a problem with constipation. This is because when children are constipated the bottom part of their bowel (the rectum), which is normally empty, fills up with poo. The full rectum then squashes against the bladder, giving it no room to fill up with urine.
Children with disabilities and additional needs are more prone to having a problem with constipation than their peers. Therefore, any child who has a day or night time wetting problem, should always be assessed to exclude constipation as a possible cause. Constipation is not always easy to diagnose as many children do not have clear symptoms indicating it is present. However, treatment may help with the bedwetting.
What can we do about bedwetting in children with disabilities?
Fizzy drinks or ones containing caffeine can irritate the bladder. They can make it more likely to be ‘twitchy’ and therefore cause bedwetting or make it worse. Not going to the toilet just before settling to sleep, drinking too much before bed or having salty or high protein food before bed can also cause bedwetting.
Things that can help to make bedwetting better:
- Make sure your child goes to the toilet just before they go to sleep
- Encourage your child to drink well during the day. Most school age children should drink about 1.5 litres of water-based drinks a day, divided between six to eight drinks
- Fizzy or caffeinated drinks should be avoided
- Try to stop all drinks and food in the hour before bedtime
- Good bedtime routines and avoiding electronic screens in the hour before bed are important
- Make sure your child is not constipated. Your GP, health visitor or school nurse can provide an assessment and suggest treatment if they are.
- If you use nappies or pull ups for your child at bedtime have a trial of three or four nights without them
If you continue to encounter bedwetting in a child with a disability, ask their GP, health visitor or school nurse about the available treatment options which may be suitable for your child.
Where can I find more information?
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.
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.