Soggy sheets, wet pyjamas, and a very embarrassed child. It is a familiar scene in many Irish homes — but bedwetting is often just a normal part of a child's development. Amanda Cassidy explores the causes and treatments of prolonged bedwetting in children
"When I see children in my clinic I draw a picture of bladders – three are big and one is very small," says Chief of Pediatric Urology, Dr Jennifer Abidari. “I ask the child which one was wetting and they’ll usually guess the smaller one, and I’ll say, ‘You’re right – you have a bladder that’s smaller than your age, and it’s not your fault.’ And I’ll see the child glance over to the parent and I’ll know there’s been a lot of conflicts.”
For most children, bedwetting is just a ‘maturational lag’
For the most part, bedwetting is a physiological issue that can often become a big problem for children as they get older. It is a fairly common condition that affects about 13% of 6-year-olds, 7% of 8-year-olds and 5% of 10-year-olds. Boys are more likely to struggle with bedwetting than girls. But nocturnal enuresis isn’t a behavioural issue that children can control. In fact, in many cases, bedwetting can run in families.
If you or your partner or extended family had issues with bedwetting, chances are that your child has inherited the same type of anatomy. Martin Scharf is the author of Waking up Dry: How to End Bedwetting Forever.
He says that for most children, bedwetting is just a ‘maturational lag’. “A child’s bladder may be too small for the amount of urine they’re producing or the muscles that contract the bladder may be stronger than the sphincter muscles that hold the urine in. Most children outgrow the condition on their own or with bladder training techniques.”
Family GP, Dr Clare Carthy says that in order for your child to stay dry, they have to have developed three important bodily functions. “The child’s body has to release enough of a certain chemical (antidiuretic hormone) at night to help concentrate his urine.
The bladder’s capacity has to increase so that there is enough room to store the urine at night and the child has to be able to recognise that the bladder is full during the night so they wake up to use the bathroom.”
So in a nutshell, it happens when it happens. When your child's brain decides to make that hormone and that brain development happens, bedwetting stops. But before that happens, they produce a lot of urine at night.
That may be useful for some parents, but for those who are washing sheets every single day, extended bedwetting can be the stuff of nightmares. Emily Procter’s six-year-old son has always wet the bed. She says she’s tried everything and worries how it will affect her son's self-esteem.
“We have done charts, plastic sheets, pull-ups (he takes them off), lifting him at night, music therapy, OT exercises and now, the alarm which we are hoping will do the trick. I've washed sheets nearly every night for two years." Emily suggests investing in a number of plastic sheets, limiting drinks before bed and even getting waterproof underwear so they don't feel humiliated by 'nappies'. She believes her reaction is also key to surviving this milestone.
"I feel really sorry for him as he is so motivated at night and determined to be dry and then feels like he’s failed every morning when he wakes up wet. I know he’ll grow out of it eventually but I don’t want this to hurt him psychologically in the process."
The emotional fallout
As children get older, it can be embarrassing for a child to be known as a bedwetter. There can often be name-calling and teasing which can damage a child’s self-esteem. Bedwetting can also mean no sleepovers which can further alienate your child among their friends. In addition, not every adult understands the nature of this disorder which can sometimes lead to anger and humiliation from parents.
Child psychologist Coleman Noctor says that being supportive of our child is essential. “Make sure they know that bedwetting isn’t their fault and that it tends to run in families. Some children admit they are afraid of getting up in the night so make sure you have a nightlight nearby or leave the bathroom light on at night.
"Never blame or punish your child for wetting the bed, praise their efforts and allow them to take an active responsibility for things like changing their sheets in the morning. Sharing responsibility for bedwetting can help a child feel as if they are actively tackling the problem and even give them a sense of pride because they can handle an aspect of bedwetting on their own."
When to worry
Generally, bed-wetting before the age of seven isn't a concern. At this age, your child may still be developing nighttime bladder control. According to the HSE, if bedwetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools or snoring it is advisable to get in touch with your doctor. Constipation has also been linked with bedwetting.
Similarly, if your child starts to wet the bed after a long period of being dry, it could be a sign of something a little more complicated.
In 2010, the National Institute for Health and Clinical Excellence in the UK issued guidelines on how to treat children who wet the bed. Interestingly, the group advises clinicians not to exclude under-sevens if they think treatment may help. So what treatments are on offer?
1. Bedwetting alarm.
This is the method that Emily believes will help her son and the studies surrounding so-called enuresis alarms are impressive. In one such study, 66% of children who used an enuresis alarm achieved 14 consecutive dry nights, compared with 4% of children who did not use one. It consists of a tiny sensor and an alarm.
You attach the sensor to the child's underwear and the sensor to their pyjamas. If the sensor gets wet, it sets off the alarm. The idea is that the alarm, over time, can help your child to recognise when their bladder is full. It is usually recommended for three to five months. Emily told us that she rented one from her enuresis adviser (incontinence specialist) as they are quite expensive to buy (between €70 and €150).
This is a short-term treatment only. A drug called desmopressin is sometimes prescribed to treat bedwetting as a more practical form of treatment (if they need to spend some nights away from home for example). It works by reducing the amount of urine your child produces at night. Not everyone likes the idea of using drugs to treat a problem in a child that is likely to correct itself but speak to your GP or enuresis adviser if you need more clarity.
3. Underlying issue
Of course, bedwetting could be a sign of an underlying condition or bladder instability. In this case, your child should be referred for specialist assessment before any treatment is initiated.
This too shall pass
Like most common issues that pop up in childhood, bedwetting can be 'just a phase'. But that doesn't mean that it is easy to live through. It can be upsetting for the household, cause difficulties for the child and parents can feel as if they are somehow responsible. It does help to know that bedwetting doesn't last forever and how you respond can have a big impact on your child (who already feels bad).
Emily says that she spent a long time researching when she should really start to worry. "I think it depends on how much it is affecting a child's everyday life. I waited to seek treatment until I felt my son really needed some support with all of this. He needs extra help moving this along now, not to mention the hell of facing washing sheets most days."
For more information on bedwetting, visit hse.ie
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