Wondering whether your child will simply grow out of bedwetting or if you could be doing something more to help them stay dry at night?
what is bedwetting?
Bedwetting is defined as involuntary urination while asleep, occurring two or more times a month in children at least 7 years old. The medical term for it is nocturnal enuresis.
It may help to think of bedwetting as the result of a communication error: the bladder and the brain fail to talk to one another effectively enough for the brain to wake up the child when it’s time to go.
Keeping dry through night is usually the last stage of toilet training. Bladder control is a biological development that cannot be hurried with star charts or pep talks. Most girls can reach this stage by the time they’re 6, while most boys can stay dry by age 7. The good news is that 19 out of 20 of children will stop bedwetting by their 10th birthday.
what bedwetting is not
Sometimes accidents happen. Your child will sleep too soundly; drink an extra glass of milk just before bedtime; forget to empty the bladder before bedtime; or have a very realistic dream in which they’re already sitting on the toilet. An isolated episode like that is not bedwetting. It’s only an issue if it occurs as often as once every two weeks.
what causes bedwetting?
Bedwetting is not a reflection of your parenting skills. Although often mistaken for a psychological problem that could be solved if only the child concentrated hard enough, the causes of bedwetting are almost always physical.
- Bladder size: The bladder may not be large enough to store the required amount of urine through the night.
- Constipation: It’s a simple matter of space sharing. If the bowels are full, there is less space for the bladder to expand.
- Deep sleep: Children who are deep sleepers, or who have trouble waking up, will often have more bedwetting issues than those who are poor sleepers. Their responses to a full bladder will not be developed enough to include a wake-up call.
- Genes: Bladder control, as with other development stages, is hereditary.
- Hormone production: When we sleep, a specialised hormone is supposed to slow down the production of urine (in medical terms, the anti-diuretic hormone concentrates the urine so that the urine is stronger but occupies less space in the bladder). This hormone is not present in babies or toddlers, and the biological ability to make it only develops with age. If your child produces large amounts of weak urine at night, it’s a sign that this hormone production ability has not yet developed in your child’s body.
- Over-reactive bladder: More sensitive bladders need more frequent emptying.
- Urinary track infection: This is a bacterial infection of any part of the urinary tract. Symptoms include a frequent need to urinate, pain during urination, and cloudy urine. Speak to your doctor if you see any of the symptoms.
Some of the causes, like infection or constipation, can be treated medically. Other aspects can be aided by training. For example, a small bladder can stretch if the child drinks more liquid during the day. Most causes, such as insufficient anti-diuretic hormone production, your child will simply outgrow.
In the meantime, pull-ups can be a useful stopgap solution, although they do need to be removed when you embark on a bedwetting programme.
When you are ready to move to the next step, keep a progress record. Praise your child for waking up to go to the toilet and for being dry in the morning. Encourage drinking plenty of water during the day and avoid fizzy drinks in the evening. Establish a routine of going to the toilet before bedtime.
Over-the-sheet mattress protectors with waterproof backing are a good way to cope with those 2am accidents – simply whip off the protector, change the pyjamas and the child is ready to go back to sleep in their own dry bed.
Bedwetting alarms, despite sounding like a drastic measure, have a high success rate if used consistently. The alarms are small and readily available, either to purchase or to hire. The alarm wakes the child or parent when the child starts to urinate, so the child can get up and use the bathroom. This is not a quick fix, because the training can take several months, but eventually the alarm teaches the child to wake up before urination occurs. Dr. Anthony Page, creator of the Eclipse and Excel bedwetting alarm systems, says: “Many parents are sceptical that a problem as confusing and frustrating as bedwetting can have a relatively simple solution. But over 50 years of international research is clear that the majority of bedwetting can be treated successfully using a bedwetting alarm. Not only that, but research shows it is the only method that has proven, long term success.”
Praise your child whenever they have a dry night, but do not make a big deal if they don’t manage. It’s all right to feel irritated when you have to change the sheets in the middle of the night yet again, but it’s never all right to show your irritation or to make the child feel bad about something that’s not their fault.
understanding bladder control
- Babies urinate through the bladder-emptying reflex: when the urine reaches a certain level, the muscles automatically squeeze to empty the bladder.
- Sometime between 18-months and 2.5-years, most children become aware when their bladder is full.
- When the child consciously controls the bladder-emptying reflex, they can hold in urine and be dry during the day. This makes the bladder stretch and, over a period of time, increases the amount of urine they can hold in.
- When the child can inhibit the bladder-emptying reflex unconsciously, they are able to stay dry at night.
when to seek professional help
Talk to your GP if:
- your child is at least 7 years old and still wets the bed; or
- they have accidents during the day; or
- they have been dry at night for 6 months (or longer) and then start to wet the bed again.
- “There are a number of medications that can help your child stay dry, but none are curative,” stresses the New Zealand Continence Association. “A child may become dry, then revert to wetting when the medication is stopped.”
- Some medication will have side effects.
emotional upset and bedwetting
Emotional stresses such as divorce, a new baby, illness or bullying can all cause bedwetting. Any course of treatment should start with identifying and relieving the child’s stress.
perspective through statistics
- If your child is 5 years old, chances are that 2-3 children in their class also have wet accidents at night.
- One out of ten 7-year-olds wet the bed.
- 97 out of 100 bedwetting kids are dry by the time they are aged 12.
Dr Yvonne Eve Walus is an Auckland-based education consultant and a mother of two.