It's never easy deciding whether to let your child go on a sleepover when they have a bed-wetting problem, as its discovery can be embarrassing and traumatic for him or her. But rest assured that bed-wetting is common, affecting 15 per cent to 20 per cent of school-aged children. And while most children (98 per cent to 99%) grow out of it, treatments are available to speed this along.
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Children normally are able to wake to a full-bladder signal to use the bathroom. However, bed-wetting children have a defective arousal response and are unable to wake fully. Therefore, when the amount of urine produced overnight exceeds their bladder capacity, the child will urinate in their sleep.
Bed-wetting has a strong genetic link, with children who wet the bed more likely to have had bet-wetting parents. Although the condition is more common among boys, women are more likely to "pass on" enuresis to their children.
It's important for parents to handle the issue with care, as bed-wetting (or nocturnal enuresis, as it's medically known) can affect the self-esteem, mental health and early peer relationships of the child.
There are many treatments for bed-wetting, the most common of which are alarm training, urotherapy and medication. Treatment can generally begin at around six years of age.
Enuresis alarm training
Alarm training is usually the first line of treatment. The aim is to train the child to withhold urinating while asleep and to wake for bathroom visits when his or her bladder signals that it's full.
The two options for alarms, which are equally as effective, are:
- Pad and bell alarms, where a mat connected to an alarm box is placed on the child's bed. The alarm is activated when the mat comes in contact with liquid
- Personal alarms, with a sensor which is either secured in a panty liner or clipped to the child's underpants. The alarm is activated when the sensor comes into contact with liquid.
Patience is key for this method: once alarm training has commenced it should be used every night until the child achieves fourteen consecutive dry nights. The child's reaction to the alarm signal is essential for treatment success and the alarm training can take two to four months before it is fully effective.
Urology covers a wide range of interventions and advice, which can resolve bed-wetting or assist with alarm training. It primarily involves:
- Ensuring the child has an adequate daily fluid intake (aim for five to six drinks per day and avoid drinks containing caffeine, including chocolate milk)
- Avoiding the consumption of fluids late in the evening or close to bedtime
- Avoiding or readily treating constipation, which can affect bladder function
- Ensuring appropriate toilet posture, such as adequate foot support when sitting on the toilet (this will help with complete evacuation of both the bowel and bladder)
- Taking bathroom breaks regularly throughout the day, encouraging the child to not postpone toileting.
Medication for treating bed-wetting is usually a short-term solution or last resort.
Desmopressin is a synthetic hormone which has an anti-diuretic effect, acting on the kidneys to reduce overnight urine production. Available as a tablet, melt or nasal spray, the drug is effective in about 70 per cent of child cases. Desmopressin may be useful for sleep-overs or school camps when alarm training isn't practical. It can also be combined with other treatments to ensure a dry night.
Another drug, Imipramine was one of the first medications used to treat nocturnal enuresis. But due to the risk of side effects, Imipramine (and other tricyclic antidepressants) are not recommended as a first-line treatment.
Other treatments for bed-wetting include simple behavioural therapies such as taking the child to the toilet during the night or rewarding the child when the are dry. Although they're not as effective as alarm training or medication, it's better than no treatment.
Drugs other than desmopressin and tricyclics and complementary and alternative interventions such as hypnotherapy, chiropractics and accupunture have also been tried, but the evidence to support their use is limited.
If your child doesn't responding to common treatments, it's best to seek specialist advice about the risks and benefits of medication, as well as other options.
Remember, a positive attitude – and compliance with treatment – is essential for treatment success. Try to create a positive environment and involve the child in decision-making so they can take ownership of the problem.
Patrina Ha Yuen Caldwell heads the enuresis service for the Children's Hospital at Westmead. She has received a number of research grants (including NHMRC, Foundation for Children, KRI Near miss grant) for her research in bed-wetting. This article was co-authored by Caroline Walsh, continence nurse at The Children's Hospital at Westmead.