June Rogers, Children’s Specialist Nurse at Bladder & Bowel UK talks about improving treatment outcomes for bedwetting.

Bedwetting (enuresis) is now a recognised as a medical condition with a number of different causes. These include not waking up to bladder signals, too much night time wee being produced, and problems affecting how much the bladder can hold. Other factors include constipation, what, when and how much children drink, whether the child snores and diet.

Dryness at night

As a result of the potential different factors the success rates of single line treatments, such as desmopressin or alarm, have on average a success rate of around 60%, telling us that potentially 40% of children will require combined or other initial treatments, aimed at addressing any other contributory factors, to achieve dryness.

Staying dry at night is a fine balance between the volume of night-time urine produced and the ability of the bladder to store that urine until morning. For treatments to be effective all contributary causal factors will need to be resolved. For example, even if a treatment, such as desmopressin, is effective in reducing any over production of wee at night to a ‘normal’ night-time volume, unless the bladder has enough capacity the child will still wet.

This highlights the important of children having a full holistic assessment prior to commencing any treatment to ensure all underlying factors have been identified and can therefore be addressed. This enables a plan of action to be put in place, based on the outcome of the assessment, and can include such things as encouraging more water based drinks, and ensuring the child goes for a wee just before sleep, for example.

Drinks

Recording when, what and how much the child drinks is helpful in identifying if the child is not drinking enough or drinking too much of the wrong type of drink at the wrong time, in the evening for example. The fluid intake needs to be optimized, with water-based drinks encouraged and restriction of carbonated and caffeinated drinks.

Constipation

Also, how often and how much the child wees will help identify if there are any underlying bladder problems and recording bowel movements will help identify if constipation is present. Constipation is often not recognised either by the child or the parent. However, it should always be excluded as, importantly, often bedwetting improves, or even resolves once any underlying constipation is treated. Any bladder or bowel problems should always therefore be addressed first.

Sleep disorders

There is now a clear recognition between sleep disorders and bedwetting. As a result, children who are reported to snore or have episodes of disrupted breathing during sleep should be referred for further assessment.

Role of diet

More recently the role of diet has been considered as a contributary factor for bedwetting, with some discussions regarding the role of dairy-based products on how much wee is produced. Salty foods are also said to cause an increase in wee production. Although the evidence is not clear it might be beneficial to suggest that these foods are restricted in the evening.

Lit screens

Using lit screens for more than two hours at a time has been shown to affect children’s sleep. Although there is currently no agreement regarding the direct impact this has on a child’s bedwetting it would seem sensible to suggest that screens are not used in the hours before bedtime.

Addressing all the potential contributary factors first will give the child the best chance of achieving dry nights.

More advice and information on 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 on 0161 214 4591 or via email bbuk@disabledliving.co.uk.

The website www.stopbedwetting.org also has a range of resources to help raise awareness of bedwetting and empower families.

Further information regarding World Bedwetting Day can be found by visiting: https://www.worldbedwettingday.com/