The Parenting Garden

Bedwetting (also known as nocturnal enuresis) is very common in children and according to the Continence Foundation of Australia, 1 in 5 children in Australia wet the bed. 

As the graph below demonstrates (provided by the Royal Children's Hospital in Melbourne), almost a third of four year olds wet the bed and are still wetting by the time they start school. Then by the time they are six only 1 in 10 wet the bed then 1 in 20 by the time they reach 10 years old. 

This shows that bedwetting does resolve itself over time but for many parents and children it becomes a source of worry, especially when it begins to effect the child's self-esteem and social life. 

So what causes bedwetting?

According to most sources, the cause of bedwetting can be due to one or a number of reasons. Research has shown there are three main causes of bedwetting in children:

• The inability to wake to the sensation of a full bladder. The bladder and brain do not communicate properly when the child is sleeping therefore the brain doesn't get the message that the bladder is full.
• Overactive bladder. The bladder may only hold small amounts of urine due to the bladder muscles spontaneously contract during sleep.
• The over-production of urine at night (due to low levels of naturally occurring substance called vasopressin) which means their body produces more urine than their bladder can hold.

There are two types of enuresis - primary enuresis and secondary enuresis. The three causes above commonly fit into the primary enuresis category where a child has never managed to achieve dryness at night. Secondary enuresis on the other hand refers to children who have achieved dryness at night but then begin wetting their bed again.

Possible causes of secondary enuresis can be:

• Constipation.
• Urinary tract infections and congenital defects.
• Hereditary where a parent were enuretic themselves.
• Emotional crisis.

When should you seek help?

You may wish to see a health professional about your child's bedwetting if you have any concerns. In particular if:

• Your child wets or has bowel movements in their pants during the day.
• Your child has been dry at night for six months then begins to wet the bed again.
• Your child is upset, angry or frustrated about wetting the bed.
• You are concerned that you might punish your child, or have punished your child for wetting their bed.

It is best to seek help from a health professional first to rule out any possible secondary causes. The doctor will assess your child and determine if there is a physical problem that may need addressing.

How can bedwetting be treated?

Once your child has been checked by a health professional to make sure there are no physical causes for their bedwetting, you can explore other solutions and forms of treatment.

Please click here for a short video by Dr Mark Gibbeson on the two main types of treatment.

Below are the most common treatment suggestions:

Bedwetting Alarms

According to the Royal Children's Hospital in Melbourne, bedwetting alarms are considered the most useful and successful initial way to treat bed wetting. Research has shown that these alarms will help more than 80% of children to become dry, and most children will then stay dry. Bedwetting alarms have good long-term success and are the fastest way of treating enuresis than any other method.

Bedwetting alarms work on the principle of conditioned learning where the brain is conditioned to be open to messages from the bladder and prevent bed wetting during sleep. When the moisture sensitive part of the alarm is activated by the first drop of urine, the alarm sounds and your child should usually wake up. The brain will react by sending a message to the bladder to stop the flow of urine. Eventually a link between wetting the bed and being woken is established and your child's mind learns to 'beat the alarm', hopefully leading to dry nights.

Medications

For children who continue to wet the bed after they've used a bedwetting alarm system, then medication may be an appropriate solution. The most common form of medication is Desmopressin and is designed to reduce the amount of urine produced at night in the same way as the body's natural vasopressin. It is available by prescription only and is given just before bed time. The main problem with medication is that it is very common for the bedwetting to return as soon as the medication is stopped. Bedwetting alarms are more likely to result in permanent success than medication.

 

References:

Continence Foundation of Australia 
https://www.continence.org.au/pages/bedwetting.html

The Royal Children's Hospital Melbourne
https://www.rch.org.au/kidsinfo/fact_sheets/Bedwetting/

http://www.treatbedwetting.com.au 

https://www.ncbi.nlm.nih.gov/pubmed/11095087
Butler RJ and Holland P. Scand J Urol Nephrol. 2000;34:270-277

Bedwetting Institute
https://www.bedwettinginstitute.com.au/pages/fact-sheet

https://www.uptodate.com/contents/nocturnal-enuresis-in-children-management?topicRef=1199&source=see_link