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Bedwetting – the Importance of Your Child’s Assessment and the Treatment Options Available

young girl asleep in bed with teddy bear

Bedwetting, sometimes called enuresis, is a common childhood problem affecting around 20% of all 5-year olds. Historically bedwetting was thought to be something children would ‘grow out’ of. However, we now have a much better understanding of the problem. It’s now recognised that bedwetting is actually a medical condition. Affected children need assessment and treatment.

What is bedwetting?

Children who are five years or older are considered to have bedwetting when they have been dry during the day for at least six months and are still wetting the bed when they are asleep. These children should have access to appropriate assessment and treatment. This includes children with additional needs. There is some misconception that for children with learning disabilities (LD), such as Down syndrome, bedwetting is a consequence of their LD and their failure to ‘learn’ to become dry at night.

However, staying dry at night is a physiological process and cannot be ‘learned’. It involves a fine balance between how much urine (wee) is produced at night during sleep, and the ability of the bladder to store that urine. Also, a crucial factor in staying dry is the ability to wake up to go to the toilet if the bladder becomes full before morning. This is often called ‘arousability’.

Why do children wet the bed?

Some children wet the bed because their kidneys produce too much urine during sleep. Other children wet the bed because of a problem with their bladder. Some children may have a problem with both. However, all children who wet the bed also have a problem, to some degree, with arousability. This means they are not able to wake up in response to bladder signals, so the bladder empties, and the bed gets wet.

We know bedwetting runs in families. Another contributory factor includes what, when and how much children drink. Constipation can also be a major cause in up to 50% of children who have bedwetting, although children and their families often don’t know they are constipated. If left untreated, the child can become so bunged up they are unable to open their bowels normally (called ‘impaction’) and start to soil.

Why is it important to treat bedwetting early?

Despite the fact we now recognise that bedwetting is a medical condition with, different causes, it is still often left untreated. Untreated bedwetting can have a detrimental effect on the child’s health and wellbeing. This may happen because families do not actively seek help. They may believe their child will get better on their own or be too embarrassed to seek help. If their child has additional needs, they may think that the bedwetting is due to the child’s disability, even if the child has been fully toilet trained in the day.

Of more concern is the fact that many health care professionals do not understand the causes of bedwetting. They may not recognise it as a medical problem, and they are often unaware that bedwetting should be treated from five years old.   As a result, treatment is delayed until the child is older and the bedwetting is having a more serious impact on their life.

We have found that giving families information about the causes of bedwetting and the range of treatments available goes a long way to make sure that affected children have the right support and advice. This helps treatment outcomes.

Where can you find help and information?

Both Bladder & Bowel UK’s children and young people resources section and the www.stopbedwetting.org website have developed a range of resources to help raise awareness of bedwetting and empower families.

The stopbedwetting.org website describes parents and carers as ‘Superheroes’ who can help their child fight bedwetting. It gives lots of tips and resources, including a check list for parents and carers about lifestyle changes that help with bedwetting.

The Bladder & Bowel UK website has a range of downloadable resources for both families and professionals, as well as links to helpful videos.

For further advice and information, do not hesitate to contact Bladder & Bowel UK via the confidential helpline, 0161 607 8219 or via email bbuk@disabledliving.co.uk.

This post was written by June Rogers, Children’s Specialist Nurse at BBUK.

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