Bed wetting is very common and is challenging for many school-aged children and their families. I have had many requests to write a blog about this. It’s a subject that children are often embarrassed to discuss; it’s very distressing for some families and can cause considerable anxiety, especially around sleepovers and school camps.
Many parents don’t know or appreciate just how common bed wetting is, and that it can usually be successfully treated. We often find that parents, uncles or cousins might also have been bed wetters when they were younger. It’s a huge relief to many kids to find out that Mum or Dad did it too! In fact, about 30 per cent of four-year-olds, 10 per cent of six-year-olds and five per cent of 10-year-olds still wet the bed.
So why do children wet the bed?
Most bed wetters are very deep sleepers and just don’t wake when they need to go to the toilet. Their kidneys may also produce more rather than less urine overnight, and they may also have what’s called “an over-active” bladder. This means the bladder doesn’t hold as much urine as it should overnight.
When should you be worried if your child is still wetting the bed?
If the bed wetting is causing distress for your child, then you should see a doctor for advice and support. We usually don’t treat bed wetting until a child is over six years old as it often gets better on its own and the treatments don’t work as well under this age. However, if your child also wets and/or does poo in their pants during the day, or they have been dry and suddenly they start wetting at night, then you should see a doctor earlier. Sometimes, there are other physical causes that need to be ruled out. Even if treatment is deferred, it’s worth having your child seen by your doctor, a paediatrician or at a multi-disciplinary continence service.
How is bed wetting treated?
The first step is to ensure that your child drinks enough throughout the day. We recommend that kids have at least five drinks a day, spread out evenly over the day. This helps to train the bladder to hold more urine during the day and at night. It is not necessary to limit drinks before bedtime as this does not make bed wetting any less likely to happen, and may be limiting your child’s fluid intake.
Using a bed wetting alarm:
If your child is over six years, it may be time to try an alarm. It is very important that your child is keen to give this a try and that everyone is positive and motivated to help make it work. I spend quite a bit of time speaking with the child to make sure they want to tackle the problem and that they are willing to use an alarm. Most are when they understand what it entails. There are two types of alarm:
1. A small alarm that clips to your child’s pyjamas with a wire that is connected to a sensor that sits between two pairs of underpants. This alarm needs to be purchased, usually online, and costs upwards of $130. It is not cumbersome and is usually well tolerated by kids.
2. A mat that the child sleeps on is connected to an alarm box that is placed at the end of the bed or on the other side of the room. These alarms can often be hired from a local hospital or pharmacy.
The idea is that when your child wets, the alarm will sound and your child needs to turn it off. They need to be properly awake, turn it off themselves and then go to finish their wee in the toilet.
You will usually be asked to keep a diary recording which nights your child wets and whether they woke to the alarm. After a few weeks, they will start having dry nights as they learn to wake to the feeling of a full bladder before the alarm goes off, or they learn to hold on and sleep through. The alarm should be used for at least six weeks, but is more commonly used for 12 weeks. The aim is to have seven dry nights in a row. It is successful in about 80 per cent of kids, but often kids need to use it for a few cycles to stay dry in the long term.
Is there a link between bed wetting and constipation?
It is also very important for your doctor to work out if your child only wets at night or whether they have daytime symptoms too, such as wetting and poos in their undies or passing of hard poos irregularly.
Constipation is very commonly associated with wetting as the bowel sits so close to the bladder. If the rectum is full of poo and pushing on the bladder, it makes the bladder more “twitchy” and unable to hold as much urine. Often parents aren’t aware that their child is constipated because they may go daily, but in fact they are only passing small amounts or the poo is very hard.
A stool softener such as OsmoLax or Parachoc daily can help a lot. The important thing to know is that constipation needs to be treated for at least six weeks – just a few doses won’t solve the problem! Also, children need to learn to sit on the toilet regularly as just softening alone is usually not enough. To ensure regular bowel actions children should sit on the toilet at least twice a day initially. After meals is a good time to do this.
Daytime wetting or soiling symptoms need to be tackled first. Your doctor will usually refer you to a paediatrician or a continence service, with continence physiotherapists, urologists and paediatricians as part of the team. As part of the assessment, they will ask you to keep a bladder diary for a week or two. I will do another blog on this soon and we can tap into their expertise.
Does medication help?
Medication is very much a second line treatment and is not usually needed. However, if your child is not staying dry even after using the strategies I’ve previously described, then a tablet or wafer called Minirin may be tried. This medication is also called DDAVP and is the same as the antidiuretic hormone ADH, which makes your body retain fluid and produce less urine overnight. This means that your child’s bladder does not get over-full and reduces the chance of bed wetting.
If started, the wafers are usually taken for three months before trying to stay dry without them. Some children only use the medication for sleepovers or school camps to make sure they stay dry. Occasionally, your child may need another medication called Ditropan which reduces the “twitchiness” or over-activity of the bladder. Ditropan is given as either a tablet or a patch on your child’s skin.
Try to remind yourself that your child is not being naughty by wetting the bed and, as hard as it to wash all those sheets, it is so important not to get angry with them or blame them. A variety of mattress protectors and pull ups or pads are available if you are waiting to get treatment started, or your child is too young for an alarm.
Bed wetting and other continence issues can be very disabling for a child, so support them to deal with it and seek help if you think it is time. There is nothing more satisfying than a child who is now dry coming back to see me, diary in hand and beaming from ear to ear. They have such a sense of achievement and excitement that they have solved their problem!
To get started with treatment, your GP will usually refer you to paediatrician or continence service for an assessment. And remember, bed wetting is very common so you are definitely not alone!
Some helpful information can be found at:
1. Continence Foundation of Australia: http://www.continence.org.au/pages/bedwetting.html
2. RCH Kids Health Info factsheet: http://www.rch.org.au/kidsinfo/fact_sheets/Bedwetting/
3. Books for boys under 10 years: David’s Secret Soccer Goals by Caroline Levine and Max Archer; Kid Detective: The Case of the Wet Bed by Howard J Bennett
4. Books for girls and boys: Sammy the Elephant and Mr. Camel: A Story to Help Children Overcome Bedwetting by Joyce C. Mills
Have you had a child who has been a bed wetter? How did you manage the problem? What worked – or didn’t work – for your family?
Please note: Dr Margie is no longer monitoring this blog. If you are concerned about your child, please contact your GP for advice.