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Bed wetting (children)

 


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Class
Urinary tract
Description
Bed wetting or nocturnal enuresis is a common childhood problem. In the UK over half a million children aged 5-12 years regularly wet the bed every year. The problem is more common in boys than girls. Most children gain night time control of urine from about 2 to 5 years of age, but occasional accidents do happen even up to 12 years of age. This should not cause concern unless it is happening frequently.
Causes
Night time bladder control takes a long time to develop. Several factors are involved, including the development of the nerves and muscles that help control the storage of urine in the bladder, the hormonal control of the production of urine during the night and the nerve pathways from the bladder that help the brain sense when the bladder is full.

Children gradually learn to recognise the sensation of a full bladder and are able to 'hold on' until a toilet or potty is found. Most children would have gained daytime control by the age of three but night-time control takes a little longer, and girls often achieve this before boys. It is normal for children as old as four to still be wetting the bed and accidents may occur for a number of years.

Why some children take longer than others to gain full bladder control at night is not clear. Their bladder muscle may be slow to develop or they may produce a lot of urine at night. There is also thought to be a genetic link as the incidence of bed wetting in children is higher if one or both parents used to wet the bed when they were children. Situations that can cause a child anxiety, such as a new school or the birth of a new baby, can delay bladder control or trigger bed wetting in children who were once dry at night. Some children might simply have a small bladder, but they can be trained to hold on, and their bladders will eventually be able to hold more urine. Wetting the bed can also occur when the child is in a deep sleep and does not respond to the sensation of a full bladder.

In rare cases, bed wetting has been linked to other causes such as a urinary tract infection, constipation or the lack of a hormone called ADH that controls the production of urine.
Symptoms
Children who wet the bed do not exhibit any symptoms, they simply wet the bed and their pyjamas. You may however come across the terms primary and secondary nocturnal enuresis. Primary nocturnal enuresis is when bladder control has never been gained. Secondary nocturnal enuresis is when bladder control has been gained for at least six months and then lost. A healthy child over the age of five with no congenital abnormalities or underlying health problems who wets the bed at least once a month, would be classed as having secondary nocturnal enuresis if they had been dry before.
Treatment
Children can often feel that they are the only ones with the problem because it is not something they can easily share with friends. If your child is bed wetting you may often wonder if there is anything you are doing wrong or if it is normal for a child to continue to wet the bed. On top of these concerns you have to cope with washing sheets all the time and worry about weekends away from home and school trips. First, stop worrying as your child is not alone and your family is not unusual in any way.

Give your child plenty to drink during the day and get them to 'hold on' as long as they can before going to the toilet. This will help enlarge the bladder and strengthen the bladder muscles allowing more urine to be stored. Try to establish a routine at night so the child is settled when they go to bed. Do not restrict drinks at night, but avoid cola drinks that stimulate urination. Always get your child to go to the toilet before going to bed. Leave a night light on so she/he need not be afraid to go to the toilet in the dark.

If your child appears to be disinterested or not bothered, it is best not to pressurise her/him.. Find out first whether your child really wants to become dry at night, as this will help your child to make sense of the methods you might be trying. Do not punish your child, tell her/him it is a normal stage to go through and it will pass. Praise them when they wake up to use the toilet in time.

A common treatment is using an enuresis alarm or buzzer. This helps your child to 'hold-on' and wake up to the sensation of a full bladder. Buzzers can be a successful form of treatment with a 70% success rate.
When to consult your pharmacist
Speak to your pharmacist if you are concerned about your child wetting the bed. Although the pharmacist is unable to recommend any particular medicines he or she will be able to reassure you that there is nothing to worry about or will advise you to see your doctor if other causes, such as a urinary tract infection, are suspected.

Your pharmacist will also be able to provide waterproof sheets or waterproof pants which will help reduce your workload.
When to consult your doctor
If your child is over five years of age and wets the bed at least once a month, if your child is distressed by the bed wetting and the alarm method has failed, or if bed wetting is interfering with daily life, you should consult your doctor. Your doctor will be able to test for a urinary tract infection and rule out other causes.

Your doctor may decide to prescribe a medicine called desmopressin. This drug works by reducing the amount of urine produced during sleep. Treatment continues until the child has been dry for at least six weeks. Desmopressin is available as tablets or a nasal spray. For children aged over 7 years, imipramine may be prescribed. It is not known exactly how imipramine works, but is thought to increase bladder capacity.

Alternatively, your doctor may refer you to a continence advisor who can teach your child exercises to control the bladder.
Useful Tips
  • Ensure there is easy access to the toilet at night
  • Encourage a good level of fluid intake throughout the day
  • Try to encourage your child to go to the toilet before bed without prompting
  • Try not to stop family holidays, sleepovers or school trips. With some forward planning and the use of disposable absorbent pants your child will be able to cope with bed wetting while being away from home. You can buy these pants in most major supermarkets and pharmacies
  • Seek help and advice from your doctor or practice nurse. Some practices may have specialist centres managed by nurses or health visitors where you can get one to one advice
  • Talk about it to other parents and remember that bed wetting is more common than you think


Based on information supplied by: Enuresis Resource and Information Centre

Freephone: 0117 960 306
Supplied by: www.enuresis.org.uk

Reviewed on 29/09/2009


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