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Reviewed by Dr John Pillinger, GP
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What is bedwetting?
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| Approximately 15 to 20 per cent of five- and six-year-olds wet
the bed, but some teenagers also have problems. |
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Enuresis is the medical name for the involuntary passing of urine and the
most common form of enuresis, ie that
which occurs at night, simply referred to as bedwetting.
The medical definition of nocturnal enuresis is bedwetting over the age of five years. Primary nocturnal enuresis is when a child has never developed complete night-time bladder control. Secondary nocturnal enuresis is when a child suffers bedwetting after having been continually dry for more than six months.
Is bedwetting common?
Frequent bedwetting is common in children up to the age of six.
The child should not be put under pressure if younger than six - children do
not wet the bed on purpose.
Approximately 15 to 20 per cent of all five- and six-year-olds
wet the bed and it is more common among boys. With teenagers, the figure is 2 to 3 per
cent up to 14 years and 1 per cent at 15 years and over.
Why do children wet the bed?
In a significant minority of children who wet the bed no reason can be found.
Often it is passed on through the family. About 70 per cent of children who wet their beds either have a brother, sister
or a parent who has experienced the same problem. Studies have localised a genetic predisposition to this condition.
It may have a medical, social or psychological cause such as constipation, kidney disease,
cystitis,
diabetes, sensitivity to certain food or food additives; and problems at
school, at home, or the
divorce of parents.
One explanation could be that these children are heavy sleepers
who do not wake up when their bladder is full. Also, some children develop
bladder control later than others.
At night, some children produce too little of the antidiuretic
hormone (ADH), which controls the production of urine. Tablets containing
desmopressin (eg
Desmotabs) may help. The child needs to be examined by a doctor who will
then decide whether treatment is necessary.
What can I do to help my child?
Try using a bedwetting alarm, which makes a ringing or buzzing
sound or vibrates if the child wets the bed. These are successful in curing the
condition in 70 per cent of cases.
The alarm is very effective because it makes your child wake up
as soon as the first drop of urine hits the underwear or the sheet. Your child
is thus made aware that they are urinating and what it feels like when their
bladder is full.
There are different kinds of alarms. Some have a copper net
which is placed under the sheet. The net is connected to a bell, which will go
off as soon as the first drop of urine hits the sheet. Others have a small
sensor, which is placed in the pants, and is also connected to a bell.
Both your GP and the local children’s continence nurse will be able to advise you on obtaining an alarm. The alarm is often required for up to five months to achieve success, being used for a minimum of three weeks following the child’s last wet night.
It is possible to use drugs and an alarm at the same time and this has been shown to be beneficial in some cases.
Do not make the bedwetting a big issue in the family. Most
children are embarrassed about wetting the bed, so it will help if the family
support the child and show a positive attitude. Don't get angry with the
child or punish them if they wet their bed. This could only make matters
worse.
Let the child know that many other children do it too. If
someone in the family has had the same problem, tell the child about it.
Knowing that others have been affected in the same way will help a child deal
with the problem.
Make sure the child doesn't drink very much during the two
hours prior to bedtime. There is still no guarantee that the child will not wet
the bed, but it may help.
Ensure the child goes to the toilet before getting into bed.
Protect the bed by using a waterproof mattress, or a fitted waterproof mattress
cover under the bottom sheet. This must be fastened securely to prevent any
danger of suffocation. Place clean nightclothes and sheets next to the bed so
the child can change if they wake up.
Let the child change the sheets; not as a punishment, but in
order to learn to deal with the problem. It will also make the child more aware
of the situation. If the child is in agreement, keep a calendar or diary and
mark dry nights with a star. Praise the child when he or she wakes up in the
morning without having wet the bed. Encouragement is often the most helpful way
of dealing with the problem.
Some children take longer than others to achieve night-time
dryness - initially having maybe one or two dry nights a week and gradually
building up the number of dry nights over the following months.
However, if your child is persistently wet every night for a
week or two he or she may not be ready to become dry. In this case, as a
temporary measure, you may wish to use absorbent night-time pants rather than
going back to using nappies. You could then try again in about three to four
months.
Many parents have been told to wake the child in the middle of
the night and make them go to the bathroom. Studies show that the positive
effect of this is almost non-existent, since the child does not wake up by him
or herself because of the need to urinate.
It may take weeks or months before there is any change. Training
a child will take time, so patience is required from all involved. Most
children naturally stop wetting the bed eventually. Do not be embarrassed to
discuss further options with your doctor or health visitor if none of the above
suggestions appear to be effective.
When should a child be taken to the doctor?
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If the child still wets the bed after the age of six.
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If the child suddenly starts wetting the bed without having
done so earlier.
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If the child's urine has a strong smell, or if the child
says that it hurts during or after urination.
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If the child starts to wet him or herself during the day.
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If the child urinates more than usual, day or night.
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If the child has
constipation or
defecates in their pants.
What will the doctor do?
The doctor will start by asking questions about the child, including when they learnt to go to the toilet in the daytime and whether or not anyone else in the family has had the same problem. After this, the
doctor will examine the child, measuring their height, feeling their abdomen and checking their spine, reflexes and external genitalia. Often, the
doctor will ask for a
urine sample in order
to rule out a bacterial infection or cystitis. The doctor may also take the child's blood pressure and arrange to take a
blood sample if kidney disease is suspected.
What kinds of medical treatment are available?
Any abnormalities detected thay may be related to bedwetting will be treated to begin with and this may resolve the problem.
If bedwetting is caused by too little of the antidiuretic
hormone (ADH), which controls the production of urine, tablets containing
Desmopressin (eg
Desmotabs) may help.
Imipramine, a
tricyclic antidepressant medicine, has been found to be useful in some cases
for reasons which are not fully understood.
Further information
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Education and Resources for Improving Childhood Continence [ERIC], Telephone: 0845 370 8008, www.eric.org.uk
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The Continence Foundation. Telephone: 0845 345 0165, www.continence-foundation.org.uk.
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References
Prescriber (2001),12 (5), 103-8.
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Based on a text by Dr Bettina Norby
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Last updated 19.11.2008
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