Bedwetting, known medically as nocturnal enuresis, may be distressing for both the child and their family, and the consequences of it may be far-reaching.
Boys tend to be affected more than girls. While it is less common with age, over 20 per cent of four-and-a-half-year-olds wet the bed for less than two nights per week, and around 8 per cent of children this age wet the bed more frequently.
Some children will also pass urine involuntarily during the day as well as in the night. In many cases, parents expect their child to be dry at night by age three, although this is often unrealistic and may not reflect any disease process.
Bedwetting may result from both physical and psychological conditions although in most cases there is no serious underlying problem.
CAUSES
Urinary tract infections (UTI) may cause a new onset of bedwetting and daytime incontinence in children who were previously dry.
In addition, passing urine more frequently than normal, pain on passing urine (known as dysuria), abdominal pain, fever and vomiting may all be suggestive of a UTI and require the urgent attention of a doctor.
Diabetes mellitus, sometimes referred to as 'sugar diabetes', presents in a number of ways in children, including excess urination (known as polyuria), incontinence, thirst, dehydration and in some cases, vomiting, abdominal pain, breathing difficulties or heart problems.
Diabetes insipidus is far less common and completely unrelated to diabetes mellitus. It is caused by disease of either the pituitary gland, which is part of the brain, or of kidney disease. There is a reduction in the effect of anti-diuretic hormone, which causes the kidneys to produce copious amounts of urine that may lead to bedwetting.
Some cases of bedwetting may be caused by a condition called overactive bladder, in which the bladder contracts too readily. More commonly, constipation, or consuming cola drinks or chocolate may lead to bedwetting.
Emotional difficulties may cause children to deliberately wet the bed or to wet the bed involuntarily as a reaction to their stress. Behavioural problems may, of course, be caused by bedwetting. In addition to bedwetting running in families, there is also a link with attention deficit hyperactivity disorder (ADHD).
SUPPORT AND PATIENCE
In many cases, reassurance, support and patience are all that is required to achieve night-time dryness. It is important to stress to the child that the bedwetting is not their fault.
Contact with support groups may prove helpful, particularly when family members are finding it difficult to cope with the bedwetting or if there is negative emotion expressed towards the child.
A referral to social services or the police will be required if there is a suspicion of child maltreatment. Suspected medical conditions, including UTI or diabetes, will require immediate assessment by a doctor.
Simple and practical measures, such as leaving the bathroom light on or using a wetting alarm, may offer remarkable success for children overcoming the problem. Young children or those with overactive bladders may only require the passage of time to achieve night-time dryness. Stopping the use of night-time nappies may provide enough motivation for a child to achieve dryness.
If motivational measures such as sticker charts fail to help, simply trying again in a few months' time, rather than putting undue pressure on the child, is often the best course of action. A sticker chart may not necessarily reward dryness, but perhaps waking their parents if they have the urge to go or if they have wet the bed, is better than laying in their urine all night. Punitive methods are not recommended.
It is sensible to avoiding letting the child have caffeinated drinks and ensuring that they void before getting into bed. However, restricting water is not recommended, as the bladder may fail to learn to cope with being full and dehydration increases the risk of constipation. If the child is constipated, this may be managed with the help of a health visitor or GP.
Some texts advocate waking the child up from sleep in order to void rather than risk bedwetting. However, this does not allow the neurological system to develop and wake the child when the bladder is full. Nevertheless, taking the child to the toilet if they are already awake is advisable. In some cases, when managing older children, medication such as desmopressin may be used in the short term.
Bedwetting is usually a problem that resolves itself with time. In a few cases, it is related to an underlying cause that requires assessment by a doctor, particularly if the child is over the age of two, and has awareness of the need to got to the toilet but nevertheless cannot achieve night or daytime dryness. If in doubt, always see your doctor.
