A Guide to bedwetting ... why it happens and how to deal with it

Bedwetting ... a difficult problem for kids and parents alike.
Bedwetting ... a difficult problem for kids and parents alike. 

Bedwetting is known medically as nocturnal enuresis, the term for when children wet the bed without waking up immediately. It can be caused by simple things like exhaustion or ailments such as viruses, constipation and UTI’s, and genetics, because there is a lot of evidence to suggest bedwetting runs in families, where the child has parents and siblings who have also been bedwetters.

It is more common that many people realise, with boys being more susceptible to it than girls, and as a parent the best way to handle the problem is not by shaming a child but explaining that happens to lots of children and trying to find out why it may be happening.

There are two types of bedwetting. Primary nocturnal enuresis is bedwetting in children who are yet to learn bladder control at night, because the link between the brain and the bladder is still developing, something which doesn’t normally happen before 3 years of age, and should be expected during the potty-training stage.

Consequently children with primary nocturnal enuresis can wet the bed several times every week with no more than a few days of dryness in a row because bladder control during the night develops after bladder control during the hours children are awake in the daytime. The time it takes to have complete bladder control will be different for each child, so primary nocturnal enuresis bedwetting can occur anytime between the ages 3 and 8.

Secondary nocturnal enuresis is when a child begins to wet the bed after previously having bladder control during the night for extended periods, and can be associated with other factors, such as loss of bladder control during the daytime (for both urine and stools) known as daytime enuresis/faecal incontinence and may indicate greater cause for concern. This type of bedwetting is more common to older children and sometimes even teenagers, and can be related to emotional distress, anxiety or an illness.

When a child experiences bladder pain or other symptoms such as very strong smelling urine, this can indicate a physical problem such as cystitis, diabetes, allergies or even possibly a kidney infection (which is often the result of an untreated UTI) and parents should seek medical advice from a doctor.

When bedwetting is happening because of an underlying emotional issue, or when night time incontinence continues after age 8 there are several things that may help to manage the problem until it passes or is treated, especially for when children are sleeping over at other people houses or at childcare, and also for family holidays:
- Having a waterproof sheet or a change of sheets by the bed.
- Enuresis alarms with a ringing or buzzing sound that help children who normally remain asleep to wake up upon wetting the bed by rousing them as soon as they begin to empty their bladder, while medication can also be used for alarm-resistant wetting under the guidance of your doctor.
- Avoiding drinks (especially drinks known to be diuretics such as soft drinks and anything containing caffeine) several hours before bedtime and using the toilet to empty their bladder as much as possible before going to sleep.
- Incontinence exercises such as Kegels exercises for daytime enuresis

Using night time pull-ups for younger school-aged children is often necessary as the children are unaware of wetting at night. Ideally for toilet training, trials of underwear at night can encourage awareness of a filling bladder, but are not always possible due to the extent of wetting.

Bedwetting is usually resolved in one of two ways, depending on the cause.

For younger children with primary nocturnal enuresis the beginning of the production of antidiuretic hormones curbs the rate of urine passing into the bladder during the night, thereby putting an end to bedwetting, while other children simply develop sleep patterns that help them to wake up when their bladder is full, both of which transpire naturally over time. At the age of 5 years, 15% of children wet at night but the good news is with no intervention, natural improvement occurs at the rate of 15% each year.

When secondary nocturnal enuresis bedwetting is a side-effect of emotional stress or illness usually treatments will be needed in order for bedwetting to stop.

For medical conditions, taking medications prescribed by a doctor such as antibiotics for cystitis or dietary changes for illnesses like diabetes or allergies usually puts an end to bedwetting quite quickly.

For emotional stress, recognising what else is coinciding with the bedwetting such as a stressful event like problems at school or a death in the family, and encouraging the child to talk about it in addition to using other stress management techniques such as keeping a diary or calming breathing exercises is the first thing to do. When there is no obvious explanation or the child is not forthcoming about why it could be happening, you may need to seek counselling to confirm it is not due to anything more serious such as abuse.

Dr Scott Dunlop is a consultant paediatrician, consulting privately in rooms at Sydney Paediatrics Woollahra, and Hurstville, as well as St George Hospital, St George Private Hospital, Hurstville Private Hospital and Sydney Children's Hospital.

Facts verified by Dr Scott Dunlop.