Bed Wetting an introduction

 
Bedwetting can be a worrying and frustrating, but it's extremely common for children to accidentally wet the bed during the night. The condition will often resolve itself in time. 

You may hear your doctor refer to bedwetting as nocturnal enuresis.

Medical treatments aren't usually recommended for children under the age of five as it's common to wet the bed at this age (though exceptions can be made if a child finds bedwetting particularly upsetting).

Bedwetting usually only becomes a concern in children who are five years of age or over and who are wetting the bed at least twice a week.

Although bedwetting doesn't pose a threat to a child’s physical health, it can have a considerable psychological impact on their self-esteem and confidence, particularly in older children.

So if your child is experiencing frequent bedwetting and is finding it upsetting, it's recommended that you contact your GP for advice.

Bedwetting can also be a frustrating and upsetting problem for parents, not only coping with its effects on the child, but having to deal with the practical and financial consequences, such as continually washing bedclothes.

Reassuring your child

Reassuring your child that everything is okay is very important if they regularly wet the bed. Your child should know that:

• it's not their fault
• they're not alone
• it will get better

You should also never tell off or punish a child who wets the bed. Not only can this cause distress, it's also likely to make the problem worse.

It is important to let your child know that his bed wetting can be solved, but you have to make sure that he understands that there is a process to follow. Sometimes, this may mean that he has more things to do before going to bed, like maybe set an alarm, but this is nothing different, than say, a child having to wear glasses. 

What are the treatment options for bed wetting?

Not using any treatment is an option, as most children will eventually stop bedwetting. The older a child becomes, the more likely that bedwetting will stop. However, treatments often work to achieve dryness sooner rather than later. Treatment options include the following:

Bedwetting alarms

A device called a pad and bell or a similar alarm device is a common treatment. There is a good chance of cure, particularly for children aged seven and older (when up to 8 in 10 children are cured). An alarm is usually needed for 3-5 months to condition the child to wake and empty their bladder when it is full. Briefly, the alarm goes off as soon as wetting starts. This wakes the child and prompts him or her to go to the toilet. In time, the child is conditioned to wake when their bladder is full before they begin to wet. Alarms can be borrowed from your local continence advisor. Your doctor can advise about this. 

Medicines  

Desmopressin is the common medicine used for bedwetting. It works by reducing the amount of urine made at night by the kidneys. It usually works well (in about 7 in 10 cases), and straight away. If it works, a common plan is to take it for three months and then try without it. However, when it is stopped, the bedwetting often returns. (A permanent cure following treatment is more likely with bedwetting alarms than with desmopressin.) Desmopressin can also be useful for short spells. For example, during holidays or for times away from home. 

Reward systems

Briefly, you agree a reward with your child if they achieve a goal. Often the goal is not a complete dry night (as most children who wet the bed have no control over their wetting.) An agreed goal could be: going to the toilet before going to bed, getting up and telling the parents they are wet, helping to remake the bed, etc. A goal of a dry night may be appropriate in some cases when the situation is improving. A common example of a reward system is a star chart. This is simply a calendar with a space for each day. A child places a sticky star on each day following a good night (where the goal was achieved) and left blank for a poor night. You may agree a reward for a number of stars.
 
Do not punish children for bedwetting. It is not their fault. Rather, they should be praised and made a fuss of if you notice any improvement. Try to be sensitive to any family or school disruption that might be stressful to your child. If bedwetting appears after a period of dryness, it may reflect a hidden stress or fear (such as bullying at school, etc).

Explaining to children

It needs your child's co-operation to be dry at night. As soon as your child is old enough to understand, a simple explanation on the following lines can be helpful. "The body makes water (wee) all the time and stores it in the bladder. The bladder is like a balloon which fills up with water. We open the bladder's tap when the bladder gets full. The bladder fills up at night when we are asleep. However, the bladder tap should not go to sleep, and should wake us up when the bladder is full."

Child's responsibility

When old enough (about age five or six), encourage your child to help change any wet sheets. It may be quicker for parents to do it, but many children respond to being given responsibility. It might also give extra motivation for them to get out of bed and go to the toilet to avoid the chore of changing the sheets. Try to make it a matter-of-fact routine with as little fuss as possible.

Getting up

Make sure there are no hidden fears or problems about getting up at night. For example, fear of the dark or spiders, getting up from a top bunk, etc. Try leaving the bathroom light on.

Drinks

Restricting drinks sounds sensible, but it does not help to cure bedwetting. The bladder has to get used to filling up and holding on to urine. If you limit drinks all day then the bladder cannot be trained to hold onto larger amounts of urine. A sensible plan is only to give drinks to your child if he or she is thirsty in the 2-3 hours before bedtime. Do not restrict drinks for the rest of the day. Most children should drink about 6-8 cups of fluid a day. 

Also, as mentioned above, caffeine in tea, coffee, cola and chocolate may make bedwetting worse. These are therefore ideally avoided, especially in the few hours before bedtime.

Lifting

It is common practice to wake children up to take them to the toilet several hours after they go to sleep. However, this lifting is of little use, and may even prolong the problem. Your child has to get used to waking up when their bladder is full. Children often do not remember being lifted, and it usually does not help to achieve their own bladder control. 

However, make sure your child goes to the toilet just before bedtime. If your child does wake in the night then you should encourage them to go to the toilet then.

Constipation

If your child is constipated, see a doctor for advice and treatment. Treatment of constipation often cures bedwetting too.

Nights away

A common worry is that staying with friends or relatives will be embarrassing. However, it is not uncommon to find that the bedwetting stops for the nights away in a strange bed. A few days away with an understanding relative or friend may result in dry nights. This may be a very positive experience and encouraging for your child.

Practical measures

Use waterproof covers for mattress and duvet, and use absorbent quilted sheets. A moisturiser cream is useful to rub on the skin that is likely to become wet, to prevent chaffing and soreness
 
Websites for advice and support:
 
http://www.bedwetting.co.uk/help-child-bedwetting.html
 
http://www.nhs.uk/conditions/Bedwetting/Pages/Introduction.aspx
 
http://www.patient.co.uk/health/Bedwetting.htm