Bedwetting

Bedwetting (nocturnal enuresis) is an extremely common and frustrating problem for children and families.

Bedwetting is involuntary urination during sleep. It is also referred to as night-time incontinence or nocturnal enuresis.  It is not a behavioral problem and may not be related to how a child sleeps.  Many parents have the perception that their children are very 'deep' sleepers and this is what has caused the bedwetting.  However, studies have shown no difference in the sleep patterns of enuretic and normal children.  There is more evidence suggesting that enuresis is the result of a developmental delay in the normal process of achieving nighttime control. The normal process involves the release of a hormone that prompts the kidneys to slow down production of urine during nighttime sleep. This hormone, called vasopressin, is not secreted in many children who have a problem at night usually.  

Sometimes bedwetting can be a response to stress, such as an emotional conflict or anxiety that a child is experiencing.  Psychologists and regularly report that children begin wetting the bed during times of conflict at home or school.  Dramatic changes in home and family life also appear to lead some children to wet the bed. Moving to a new town, parent conflict or divorce, arrival of a new baby, or loss of a loved one or pet can cause insecurity that contributes to bedwetting.  Often children are not even aware of their emotions and can't believe that there is a link between their feelings and bedwetting.  

To diagnose and make the treatment easier, doctors at times classify bedwetting problems into two types, one is primary bedwetting (Primary Nocturnal Enuresis) and the other is secondary bedwetting (Secondary Nocturnal Enuresis - SNE).

Primary Nocturnal Enuresis -  Primary nocturnal enuresis (PNE) is the most common form of bedwetting. Bedwetting counts as a disorder once a child is old enough to stay dry, but continues either to average at least two wet nights a week with no long periods of dryness or to not sleep dry without being taken to the toilet by another person.

Secondary Nocturnal Enuresis-   Secondary nocturnal enuresis may be caused by  psychological  issues, (eg. death in the family, extreme bullying) and is often associated with stress.  It may also result from an acquired condition such as diabetes, overproduction of hormone by the thyroid gland (hyperthyroidism),  seizure disorder  (eg epilepsy), and  obstructive sleep apnea  (OSA).

The psychological effects that bedwetting can have on children  are stronger than we may think. Parents should be supportive  and understanding of the problem, realising that it is entirely sub/unconscious.  Bedwetting can destroy a child's self esteem, and limit their desire to engage  in overnight activities with friends, or go on camping or other overnight adventures where they'll be in a room or bed with other people.  They will likely suffer humiliation from siblings or friends who are aware of the problem as well.  Children who have wet the bed in the past have ranked it as the 3rd most stressful event in their lives.  

 Knowing enough about bedwetting to make solid, informed choices cuts down on the fear factor. If you apply what you've just learned about Bedwetting, you should have nothing to worry about.

There are a range of treatments you can try:

Pad and bell alarms

This is the classic bed-wetting alarm, and is considered by those in the know, as the most straightforward and effective way to help your child get dry, and to keep him dry. The rubber pad, which slides in between the mattress and bottom sheet, and bell works by going off - very, very loudly - when urine hits the pad. This will (hopefully!) wake your child and, over time, teach him to wake when his bladder is full. While extremely successful for many children, this treatment can take many weeks to work, (on average children need to use the alarm for at least 10 weeks, and many need it for several more months).

TIP!

If your child is a deep sleeper, you may have to wake him up when the bell rings for the first few nights. Most deep sleepers then get used to responding to the sound of the bell.

Body sensor alarms

These alarms aren't as loud the pad and bell alarms and so are a little kinder to the family. Body sensor alarms work by securing a sensor between two pairs of underpants (that your child is wearing) and then threading the attached cord up through his pyjamas and fixing the bell either to his pyjamas top or on his pillow. Bell will be triggered - which, again, will wake your child - when the sensor picks up moisture in the underpants.

Bladder training

This is a treatment plan that should involve a health professional. Some children don't drink enough during the day (and may actually restrict how much they drink to try to avoid wetting the bed at night) and this can cause the bladder to shrink and subsequently send signals to the brain that it needs to empty long before it is at capacity. With bladder training, your child learns to drink and hold a much larger volume of fluid. This usually results in the bladder holding enough fluid overnight.

Mattress protection

You may choose to let time do the hard work and just wait until your child becomes dry at night. If this is your plan of action, you'll need to use a mattress protector to keep his mattress dry. Make sure that the protector isn't 'breathable' (in this scenario, you don't want the mattress to be able to 'breath' as this will only mean that it will get wet) - it needs to completely cover the mattress and it must be made out of 100% plastic. Rotate the mattress regularly and try to take it outside into the sun occasionally to air it. 

Protective underwear

 

Even though there are now pull-ups for big children available, it's unlikely that using these as a permanent way of getting around bed-wetting problems will ever actually solve the problem. With pull-ups, your child will continue to 'wet' the bed without ever learning how to solve the problem. Pull-ups are a great solution, however, for sleepovers and school camps - anything that is temporary and that will cause embarrassment if the bed is wet. 

 

Medications

 

Most children who wet the bed don't need any drug treatment, but there are some occasions when it can be useful. The most well-known drug is Minirin (DDAVP). This is a man-made form of anti-diuretic hormone (ADH) that works by substituting for the natural hormone. It will help your child's body make less urine at night, and so reduce the risk of his bladder overfilling during sleep. This is usually reserved for children who have failed previous treatment with a bed-wetting alarm, and sometimes the two treatments are then given together. Some children only use the medication for sleepovers or school camp. 

 

Toileting at ten o'clock

 

Some children respond well to being taken to the toilet several hours after they've gone to bed. Over time, they will learn to do a wee on command (and perhaps not even remember it in the morning).

All in all be patient.  Most children grow out of bedwetting.