Mum – I wet the bed again!!!
Bed wetting is embarrassing and frustrating but common and not usually a cause for concern. However, it is important for parents to understand what is happening and what we can do about it.
Firstly, when should we worry?
As doctors, we worry when bed wetting is accompanied by other symptoms, such as:
if your child is wetting during the day
if they are complaining of burning when they are doing a wee
if they are constipated
if they are losing control of their bowels
if they are unable to pass urine when they feel they need to
if they see blood in their urine
if they are getting urine infections
We also worry if the bed wetting is new. This is called secondary enuresis (or bed wetting). If they have been dry at night for at least 6 months and then they suddenly start bed wetting, this warrants a visit to the doctor.
The sorts of things doctors need to rule out are:
Emotional trauma
Constipation
Urinary infection
Sleep apnoea
Spinal issues
Developmental issues, or
Endocrine or hormonal issues such as diabetes.
Most children achieve daytime dryness by 4 years of age and nighttime dryness by 5–7 years of age. However, there is a lot of variation in this. Factors which influence when kids achieve nighttime dryness include:
ReferencesGenetics: or when you as their parent achieved nighttime dryness. If parents were late, their children will often be late.
Whether or not your child is a heavy sleeper. Heavy sleepers will have reduced arousal when they have a full bladder.
Children with small bladder size.
Children whose kidneys make a lot of urine overnight (usually we make less when we sleep).
So, if you are confident your child has not been dry for a 6 month period and there are no other worrying features such as blood in the urine or constipation, how do we manage this?
Firstly, reassure your child that bed wetting is normal. There are probably a lot more kids going through the exact same thing, than your child realises.
Secondly, train their bladder to tolerate a normal amount of fluid. Make sure they drink a good amount of water throughout the day and take regular toilet breaks. Some kids who wet the bed go to the toilet far too often throughout the day and fluid restrict to try and prevent bed wetting. Not only will this not work but it might actually backfire as their bladder will get used to being under filled and will not tolerate holding a larger amount of fluid. This will increase the risk of wetting the bed at night.
Thirdly, once you are sure they are passing a good amount of urine when they do a wee during the day, you can talk to them about a night alarm. We don’t usually recommend these before the age of 7 years and we like parents and kids to be on board with the process. It can take up to 6–8 weeks to work. We also recommend contacting the Continence Foundation of Australia. They have a lot of excellent resources and as well as people who can support you through the process.
It needs to be the child’s responsibility to turn the alarm off and reset it when there is an accident. If there is an accident, they still need to get up and go to the toilet to complete the urination. If they are a deep sleeper, a parent may have to wake them up the first few times but eventually even a very deep sleeper will start to wake up to the alarm.
You can use reward charts that reward behaviours such as waking up and going to the toilet rather than staying dry. Once they are completely dry for 2 weeks, you can stop the alarm. If there is no response after 4 weeks, stop the treatment and if there is only a partial response after 3 months, stop for a while and try again in another 3 months. If this continues to fail, they will require referral to a paediatrician.
There is no evidence to support parents waking a child and carrying them to the toilet at night to prevent bed wetting.
There is a medication called desmopressin, which stops urine being produced at night which can be used in emergency situations such as a sleepover or a school camp. It can be used longer term if the alarm therapy is not working but the risk of relapse is high when it is withdrawn so it is not often used. It also needs to be used under close medical supervision as there is a risk of low sodium levels with its use.
References
The Royal Children’s Hospital: Clinical Practice Guidelines. Enuresis – Bed wetting and Monosymptomatic Enuresis.
Nocturnal Enuresis Resource Kit: 2nd Edition. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.continence.org.au/sites/default/files/2020-05/Academic_Nocturnal_Enuresis_Resource_Kit_second_edition.pdf [22/10/2024].
Bedwetting in Children. Continence Foundation of Australia. https://www.continence.org.au/incontinence/who-it-affects/children/bedwetting-children. [29/10/2024].