Davina Richardson, Children’s Continence Nurse at Bladder & Bowel UK, talks about how to support and treat your child who experiences bedwetting at Christmas.
Enuresis, or bedwetting is a common condition in children and young people. However, it can be very distressing and frustrating for them and for their families. For many it causes, low self-esteem, can lead to sleep difficulties, and psychological issues and many worry about the possible embarrassment if others finding out.
What is bedwetting?
Bedwetting is a recognised medical condition that results in the bladder emptying during sleep. It is also known as enuresis or nocturnal enuresis. Affected children and young people cannot help the problem. It is not caused by anything they or their family are doing wrong or are not doing. It is not caused by laziness or naughtiness.
While bedwetting can be made worse by stress, it is not usually caused by this. Rarely it can be linked to other medical conditions. Therefore, if your child has suddenly started wetting after a period of being dry, you should ask their healthcare professional (GP or school nurse) for help and advice.
What causes bedwetting?
There are different causes for bedwetting. If the brain is not able to fully wake a child or young person up when the bladder signals that it needs to empty, then the bed will get wet. However, most children and young people can sleep through the night without needing to go to the toilet.
If the bladder is not working well enough to be able to hold all the urine that is made overnight, then it will need to empty during the hours of sleep. If the child or young person cannot wake, the bed will get wet. Some children with bedwetting also have problems with bladder function when they are awake. These children may experience some urine leaking during the day: they may get damp or wet underwear. Some may go to the toilet more often than usual (frequency) or they may have to get there quickly than usual (urgency). This can appear to families as if they are leaving it to the last minute to go to the toilet, which is not usually the case: it is the bladder ‘twitching’ at any point during filling, which causes a sudden, strong and unexpected need to get to the toilet quickly.
Most children and young people can reduce urine production during the night, so that the bladder is able to hold all that is produced while they are in bed. However, if the kidneys are making too much urine while the child or young person is asleep and they are not able to wake to the bladder signals, the bed will get very wet.
Is there anything that can be done to help with bedwetting?
Constipation can also cause bedwetting or make it worse. This is because the full bowel can put pressure on the bladder. Therefore, it is important to try to prevent constipation through a good fluid intake, and by encouraging your child or young person to eat a diet that includes plenty of fruit and vegetables. If you think they may be constipated, then speak to their healthcare professional. Constipation in children and young people does usually need to be treated with laxatives.
Drinking well during the day helps the bladder to work well. This in turn helps it to hold urine better during the day and at night. Most primary school age children should be drinking about 1.5litres of water-based drinks a day; teenage girls should be having 1.5-2 litres and teenage boys 2 -2.5litres a day. Drinks should be divided up so that all children and young people are having a water-based drink about every two hours, or six to eight drinks a day.
Drinks that are fizzy and drinks that contain caffeine, such as tea, coffee, hot chocolate, cola and many energy drinks, should be avoided. This is because fizzy drinks and caffeine can irritate the bladder lining and increase the likelihood of being wet. Milk is considered a food rather than a drink.
Children should have their last drink of the day about an hour before bedtime. Drinking late in the evening does not give the kidneys enough time to get rid of any excess fluid before sleep, so may make bedwetting worse. However, stopping drinks too early in younger children may make it more difficult for them to drink as well as they should during the day. Young people, who go to bed later, may stop drinks up to two hours before bedtime.
Emptying the bladder just before settling to sleep is also important, particularly for children who play or read in bed. Avoiding screens, such as TVs, electronic tablets, computers, phones etc, just before sleep may also help as the type of light given out by the screens cause unsettled sleep patterns and trick the body into continuing to make wee at the daytime rate, rather than at the lower night time rate.
A good bedtime routine may also be helpful. Some children and young people are more prone to wetting if they are very tired due to late nights, others are more prone to wetting if they go to bed early, as they are in bed for longer as their bladder may not be able to hold on for this extra time.
Are there any other treatments for bedwetting?
If the measures outlined above do not help, then medication or an alarm may be appropriate. There is a medication called Desmopressin that helps to tell the kidneys to make less urine overnight. This is available on prescription from your healthcare professional and there is more information about it in the Bladder & Bowel UK leaflet at Understanding Desmopressin (Desmomelt) – for parents and carers.
Alarms are devices that make an intrusive noise when the child starts to wet. They can be attached to pyjamas (body-worn alarms) or have a mat that goes under the top sheet (bed mat alarms). The noise is designed to wake the child as their bladder starts to let go, so that they can get up and go to the toilet. They can take some time to be effective. While it is not clear exactly how they work, they do help some children to learn to wake to the bladder signals, others learn to hold on all night. There is more information about alarms at Using alarms as a treatment for bedwetting – for parents and carers
Some children may need other medication to help the bladder work well and some children need to have more than one treatment. Therefore, bedwetting in children over five years old should be assessed by a healthcare professional.
Why Christmas can be a good time to think about managing bedwetting?
Children and young people usually spend most of the Christmas holidays at home with their family. Most children need support to establish good drinking and toileting patterns and this is easier when everyone has time at home. Also, although there may be more sweets and chocolates around, traditional festive foods tend to include lots of fruit and vegetables. These can help to prevent constipation, which may make bedwetting worse.
The holidays can be a good time to start using a bedwetting alarm. The alarm will disturb you and your child or young person when they wet during the night. However, holiday times may allow you and them to catch up with lost sleep, by getting up a bit later in the morning if they do not have to go to school and you do not have to go to work.
If you have tried the initial adjustments to your child’s routine and the bedwetting is not improving and they are over five years old, then you can ask their healthcare professional for assessment and further treatment.
Where can I find more information about bedwetting?
There is more information about bedwetting on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/resources-for-children/ and in other blogs on the Bladder & Bowel UK website at https://www.bbuk.org.uk/?s=bedwetting. There is also information on the website at https://stopbedwetting.org/
Where can I get more advice and help?
Your child or young person’s GP, school nurse or health visitor should be able to provide more information and initial assessment. They may be able to refer your child to a local service for support. You can also contact the Bladder & Bowel UK helpline for free confidential information and advice via the webform at https://www.bbuk.org.uk/helpline-enquiries/ or on the telephone at 0161 214 4591
For more information and resources for professionals working with bladder and bowel issues, visit our professionals’ section here.