Managing Bedwetting in Children with Down Syndrome
This post has been written by Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK. Bedwetting is a common childhood problem that can affect any child. Having a learning disability or Down Syndrome is not a reason for bedwetting. Children aged 5 years and older with a learning disability, such as Down Syndrome, who are toilet trained during the day and who are still wet at night should always be offered help. 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 and treatments for bedwetting are available.
Bedwetting (sometimes called Nocturnal Enuresis) has a number of different causes. Staying dry at night is a fine balance between how much urine (wee) is produced during sleep and how well the bladder can hold on to (store) the amount of urine produced. If the bladder gets full before morning the child has to be able to wake up, get up and go to the toilet. A problem in one or more of those areas can result in the bed getting wet.
Most children manage to sleep through the night without needing to wee because their kidneys make less urine when they are asleep at night and their bladders are big enough and work well enough to hold all the wee they do make.
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 lots more wee at night than they should, so the bladder will not be able to hold it all. For some children their bladder is not big enough to hold all the wee they make when they are asleep. Others have a bladder that is big enough, but it gets ‘twitchy’ and empties before it is full. If they do not wake up when their bladder is full, or if it is ‘twitching’ it will empty and the bed will be wet.
Constipation can also cause bedwetting or make it worse.
This is because when children are constipated the bottom part of their bowel (the rectum) fills up with poo which then squashes against the bladder, giving it no room to fill up with wee. However, it is not always easy to know when children are constipated. Any child, who has day or night time wetting, should be assessed for constipation as a possible cause of the wetting.
Fizzy drinks or ones containing caffeine can irritate the bladder and make it more likely to be ‘twitchy’ and therefore cause bedwetting or making it worse. Not going to the toilet before going 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 be drinking about 1.5 litres of water-based drinks a day, divided between six to eight drinks
- Try to avoid your child having fizzy or caffeinated drinks
- Try to stop all drinks and food in the hour before bedtime
- Try to keep good bedtime routines and to avoid electronic screens in the hour before bed
- Make sure your child is not constipated and if they are ask their GP, health visitor or school nurse for assessment and treatment of this
- If you use nappies or pull ups for your child at bedtime have a trial of three or four nights without them
If the bedwetting continues then do ask their GP, health visitor or school nurse about treatment options which may be suitable for your child.
There is more information on the BBUK website, with a leaflet about treating bedwetting in children with Down’s syndrome. There is also information at www.stopbedwetting.org
Bladder and Bowel UK also provide a confidential helpline. Email firstname.lastname@example.org or telephone 0161 607 8219.