Bedwetting

Page last reviewed: 13/07/2011

Bedwetting is a common childhood condition. It occurs when there is an involuntary (accidental) loss of urine during sleep. The medical name for bedwetting is nocturnal enuresis.

Bedwetting is normal in children who are under five years old, and the majority of young children will wet the bed at some stage.

Sometimes it affects children who are over five and, occasionally, young adults.

Bedwetting is often caused by an overactive bladder, but it can be the result of problems with the development of the bladder. It can also be due to a neurological disorder (disorders of the brain and nervous system).

Types of bedwetting

There are two types of bedwetting:

  • primary nocturnal enuresis: persistent, involuntary bedwetting during sleep in a child who aged five or over, and
  • secondary nocturnal enuresis: where bedwetting comes back after a dry period of at least six months.

Secondary nocturnal enuresis is often linked to a stressful event, such as bullying at school, or the divorce of a child's parents.

How common is bedwetting?

Bedwetting can be a disruptive and stressful condition that is thought to affect around:

  • 15% of all children,
  • 45% of children with a parent who has also had the condition, and
  • 75% of children with two parents who have had the condition.

Self esteem

If your child wets the bed, it is important for you to know that it is not their fault, and that they have no control over it.

Don't punish your child for wetting the bed. This can have harmful psychological effects, such as lowering their self-esteem.

Outlook

A child usually wets the bed because the amount of urine that they produce is more than their bladder can hold, and they do not wake up even though their bladder is full.

Bedwetting usually stops when the child gets older, because:

  • their bladder capacity increases,
  • they produce less urine at night, and/or
  • they learn to wake up when their bladder is full.

In time, almost all children stop wetting the bed, often without treatment. Approximately 1% will continue to wet the bed into adulthood.

Page last reviewed: 13/07/2011

If your child wets the bed (nocturnal enuresis), this means they are regularly losing control of their bladder and passing urine at night, during sleep.

When to seek medical advice

If your child only wets the bed occasionally, it is probably not a cause for concern.

If it happens on a regular basis, or if it is causing your child and other members of your family distress, you can get advice from your GP.

Page last reviewed: 13/07/2011

There are a number of causes of bedwetting (nocturnal enuresis), and sometimes there may be more than one underlying cause.

Overactive bladder

An overactive bladder is a common cause of bedwetting. This is when the bladder wants to squeeze out urine before it is full, or before you are ready.

An overactive bladder often causes urge incontinence, where you have a sudden urge to urinate and you are unable to hold it in.

Underlying health conditions

Bedwetting can also be caused by a number of underlying health conditions. For example:

  • congenital abnormalities (present at birth) such as an ectopic ureter (where the tube through which urine passes does not lead to the bladder), or
  • neurological disorderssuch as spina bifida (a condition that affects the development of the spine and nervous system).

Other causes

Bedwetting may simply be caused by drinking too much fluid. It can also be the result of a number of chronic (long-term) conditions, such as:

  • diabetes,
  • constipation,
  • urinary tract infections (UTIs), and
  • emotional problems.

In some cases, bedwetting can be a sign that your child is upset or worried. Starting a new school, being bullied or the arrival of a new baby in the family can all be stressful for a young child.

If your child has started wetting the bed after being dry for a period of six months or more (secondary nocturnal enuresis), it is likely that stress or anxiety is causing it.

Glossary

Constipation
Constipation is when you pass stools less often than usual, or when you are having difficulty going to the toilet because your stools are hard and small.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Page last reviewed: 13/07/2011

Take your child to see your GP if they are:

  • wetting the bed at night (nocturnal enuresis) on a regular basis, and/or
  • feeling distressed about their bedwetting.

Assessing your child's bedwetting

To find out more about your child's bedwetting, your GP will want to know:

  • how often the bedwetting occurs,
  • how much fluid your child drinks before they go to bed,
  • how well you and your child are coping with the problem, and
  • whether there is anything bothering or worrying your child, such as being teased or bullied.

Your GP will also ask if your child has had a urinary tract infection (UTI) or any other health conditions.

Ruling out underlying conditions

To find out whether your child's bedwetting is linked to a current infection or health condition, your GP may carry out a physical examination.

They will want to know whether there is an underlying health condition that is causing your child's symptoms, such as diabetes or a urinary tract infection (UTI).

To do this, your GP will test your child's urine for a number of substances, such as blood, glucose and nitrites (chemical compounds). They may also send a sample to a laboratory for further testing.

Page last reviewed: 13/07/2011

Sometimes, bedwetting (nocturnal enuresis) stops on its own without the need for treatment.

Your GP may not recommend a treatment, particularly if the bedwetting is not affecting your child too much. This is because:

  • treatments for bedwetting do not always work
  • treatments require motivation and commitment
  • in time, almost all children will become dry, even without treatment

If the bedwetting does not clear up, or it is having a big effect on a child, a treatment may be recommended.

Recent NICE guidelines

The National Institute for Health and Clinical Excellence (NICE) In the UK produced guidelines in October 2010 on how to treat children who wet the bed.

Historically, it has been common practice to only consider treating children for their bedwetting when they reach seven years of age.

However, NICE now advises clinicians to not exclude the under-sevens from bedwetting treatments if they feel treatment is necessary.

Read the NICE 2010 guidelines on bedwetting

Generally, treatment for bedwetting may be recommended if it is having a significant impact on the child or their family.

The decision to go ahead with treatment should be made jointly by the child's parents (or carers) and the child after considering:

  • how often the bedwetting occurs
  • how the child and parents are coping with the problem
  • whether the child is being punished, bullied or teased due to their bedwetting

Recommended treatments

Your GP may refer you to an enuresis adviser (an incontinence specialist) who will be able to recommend specific treatments for bedwetting.

The type of treatment that the enuresis adviser recommends will depend on your child's situation, such as their age and previous bedwetting  history, as well as any underlying conditions that may be causing it.

Enuresis alarms

Enuresis alarms are considered to be the best form of long-term treatment for bedwetting. This is usually preferred to the use of a medication called desmopressin (see below).

An enuresis alarm consists of a tiny sensor and an alarm. The sensor is attached to your child's underwear and the alarm is worn on the pyjamas. If the sensor starts to get wet, it sets off the alarm. Vibrating alarms are also available.

Over time, an enuresis alarm can help your child to recognise when their bladder is full and it's time to wake up to go to the toilet.

You may be able to borrow an enuresis alarm from your enuresis adviser or they will advise you whereb to purchase them.

Using an enuresis alarm is usually recommended for three to five months. After 14 consecutive dry nights with a normal fluid intake, encourage your child to drink more fluid to train their bladder.

There is evidence to suggest that training the bladder to cope with extra fluid helps to reduce the chances of bedwetting coming back. At first the training process may lead to further bedwetting, so make sure your child knows to expect this.

After 14 consecutive dry nights with increased fluid intake, your child can stop using the enuresis alarm. If bedwetting reoccurs after you have stopped using the alarm, start using it again.

Enuresis alarms are not recommended if:

  • a child shares a bed,
  • more than one child in a family is being treated at the same time, or
  • a child's parents or carers are unable to provide appropriate support.

Studies have shown that 66% of children who used an enuresis alarm achieved 14 consecutive dry nights, compared with 4% of children who did not use one.

About 50% of children who used an enuresis alarm experienced a relapse (reoccurrence) after treatment stopped, compared with almost all children who did not use one.

Desmopressin

Desmopressin is sometimes prescribed to treat bedwetting. It is usually taken orally (in tablet form) and is only recommended as a short-term treatment.

In certain situations, taking desmopressin is a more practical form of treating bedwetting than using an enuresis alarm. A short course of desmopressin may be prescribed for your child if they need to spend some nights away from home, for example if they are going on holiday abroad or on a school trip.

Desmopressin works by reducing the amount of urine that your child produces and needs to pass at night. If your child is prescribed desmopressin, it is important that they follow the recommended amount of fluid intake in order to avoid becoming overloaded with fluid. Your GP or enuresis adviser will be able to advise you about this.

In rare cases of bedwetting where using an enuresis alarm is not possible, or has proven to be ineffective, the long-term use of desmopressin may be recommended. For example, long-term use of the medication may help to reduce the frequency of bedwetting in situations where it is causing a child significant distress.

However, due to the risk of your child becoming overloaded with fluid and developing hyponatraemia, close monitoring and careful management is required if a long-term course of desmopressin is prescribed.

Hyponatraemia is a condition that is caused by a dangerously low level of sodium (salt) in the blood as a result of drinking too much fluid.

Combined treatments

If your child's bedwetting does not improve after trying individual treatments, a combination of treatments, such as an enuresis alarm and desmopressin may be recommended. However, there is no evidence to confirm whether combining treatments produces a more effective outcome.

Other medications

Tricyclic antidepressants, such as imipramine, are not recommended, because they can cause very serious side effects.

Oxybutynin is also not recommended, because it has been found to be ineffective in treating bedwetting that is not caused by bladder instability.

If bedwetting is the result of bladder instability, the child should be referred to a specialist for assessment before any form of treatment is started.

Glossary

Acupuncture
Acupuncture is a complementary treatment that uses needles on specific parts of the body.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Urine test
Urinalysis / UA is when a urine sample is tested, commonly to check for any signs of infection, or protein or sugar levels.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Advice for parents

Reassure your child that bedwetting is not their fault.

Reward your child for agreed behaviour rather than for dry nights - for example, reward them for drinking the recommended levels during the day, for going to the toilet before sleep, or for helping to change the sheets.

Tell your GP if you feel you need support, particularly if you are having difficulty coping with the bedwetting or you are expressing anger towards your child.

Page last reviewed: 13/07/2011

In many cases of bedwetting (nocturnal enuresis), it may be possible to help your child stay dry throughout the night without treatment.

The advice listed below may prove useful in preventing bedwetting.

  • Your child should drink normally throughout the day. However, they should not drink during the couple of hours before bedtime, particularly caffeinated liquids such as cola and other fizzy drinks. Caffeine is a diuretic, which means that it encourages the body to produce more urine.
  • Encourage your child to empty their bladder by going to the toilet before they go to bed.
  • Ensure that your child has easy access to the toilet at night. For example, if they have a bunk bed they should sleep on the bottom. You may also like to leave a light on in the bathroom and put a child's seat on the toilet.
  • Use waterproof covers on your child's mattress and duvet, and absorbent, quilted sheets. After a bedwetting, use cold water or mild bleach to rinse your child's bedding and nightclothes and then wash them as usual.
  • Following a bedwetting, older children may wish to change their bedding at night to minimise disruption and embarrassment. If so, have clean bedding and nightclothes available for them.
  • After your child has wet the bed, wash them thoroughly (including their hair) before re-dressing them. Use a simple emollient (moisturiser) on your child's skin to help prevent chapping (red and irritated skin). If necessary, after a bedwetting, spray the room with a deodoriser.
  • Have a neutral attitude to bedwetting, to minimise your child's embarrassment. This means not blaming your child for wetting the bed, and taking positive steps, such as those listed above, to resolve the problem.
  • Do not punish your child for wetting the bed. Doing so can make things worse by humiliating them and lowering their self-esteem.
  • Use a reward system, such as a star chart (awarding coloured stars when your child has a dry night) to encourage positive behaviour. You could reward your child for behaviour that helps to stay dry at night, such as drinking plenty of fluids during the day, or getting up to use the toilet at night.

Glossary

Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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