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Why is an assessment an important part of treating bedwetting in children?

Children receiving an assessment or playing with adults

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, we discuss the importance of bedwetting assessment for children. 

What does a bedwetting assessment involve?

A bedwetting assessment will help to work out the cause of the bedwetting. It will also give the child and family the opportunity to discuss appropriate treatment. It is important to involve the affected children or young person in the assessment. They should participate in the treatment.

The history is one of the most important parts of the assessment.  You may be asked about your child’s general health, toilet training and daytime toileting habits, as well as about their sleep and behaviour.  You will be asked about whether the bedwetting has always happened, or if there has been a period when your child had dry nights.

The assessor will ask families to keep records of the child’s bowels for at least two weeks before an initial appointment. This it to make sure that there is no underlying constipation, which can cause bedwetting and affect treatment success.  You may also be asked to keep a bladder diary for two to three days before the appointment. The bladder diary will give important clues as to how well the child’s bladder is working and how much urine it is able to hold.

Finally, you may be asked to keep a record of your child’s wet nights for about two weeks before any appointment.  You may be asked to record whether they are wet or dry, whether they wake to use the toilet at all and how big any wet patches are or how heavy their nappy or pullup is if they wear one.

What is the health care professional looking for when they do a bedwetting assessment?

The assessment will try to work out any underlying causes for  the bedwetting.  Many children have bedwetting because the kidneys are making more urine at night than their bladder can store. In some children the bladder is not storing urine as well as it should be.  All children who wet the bed do so because their brains are not able to wake them to the bladder signalling that it needs to empty.

Children who are making too much urine at night are usually very wet. Often they have large wet patches on their bedding. Alternatively, if they use nappies or pull ups these are very heavy or may leak.  This problem means that children are often wet in the early part of the night.

Some children have bladders which are smaller than they should be, or whose bladders are not holding urine as well as they should. They may pass different amounts of urine on different nights, so the wet patches vary in size.  In this case, wetting may happen at any time of the night and are more likely to wake up after they have wet.  Some children with this problem also have difficulties with bladder storage during the day. They may have to rush to get to the toilet, go to the toilet more than seven times a day and/or may get some damp or wet underwear during the day.

Secondary bedwetting is when children who have been dry at night for at least six months then start to wet again. This can happen for a variety of reasons. Stress or anxiety might contribute. Occasionally there may be a link to an underlying medical condition, such as constipation or urinary tract infections.  This is why assessment for secondary bedwetting is important.

How does an assessment help with treatment?

The assessment will help you, your child and their healthcare professional work out what is the most likely cause of the wetting in your child. The nurse will then discuss their suggestions for treatment with you.

If your child is dealing with constipation, it may be that they suggest treatment for this first. It is usual to treat daytime bladder issues before tackling the night time wetting.  The medication Desmopressin is a common treatment for night-time wetting. This helps the kidneys to make less urine at night. Another option is an alarm. An alarm helps the children to wake before they need the toilet, or to be able to hold their urine throughout the night.

For more information on treatments look out for the Bladder & Bowel UK blog about this.

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.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day 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.

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