Bedwetting: causes and solutions

Most young children wet the bed from time to time. However, if bedwetting continues as the child gets older, should you be worried? Why do children wet the bed? And how can we help our children? Consultant Paediatrician Dr Kishor Tewary is here to explain.

Bedwetting is normal up to the age of five, after which it is termed as “nocturnal enuresis”. Around 15% of children still have this issue at age five; 7 % at age 10; and around 2% of pubescent children have long-term issues.

While it often appears as a subtle and private problem to a child, it can often be very disruptive in their daily life and developing self-esteem. It can sometimes lead to long-term social or psychological issues if not managed sooner rather than later.

Why does bedwetting happen?

It mostly occurs due to a lack of synergy between bladder and brain, but sometimes it can be due to lack of a hormone called vasopressin, which is required to suppress urine production at night, or, less commonly, due to an overactive bladder (which is often combined with day time problems as well).

It can often present as a “secondary” problem after any insult to the bladder i.e. urinary tract infections (UTIs), a bad voiding pattern, or even due to disruption in their social life. Very rarely, it can be secondary to a neurological problem.

More about UTIs in children

How is the cause diagnosed?

The diagnosis is mostly based on good history-taking and a physical examination. In certain cases, there may be need of further investigations with ultrasound for the kidneys/bladder or bladder voiding studies to assess the structure and function of the bladder.

How can I help?

I have a special interest and a lot of experience in childhood kidney/bladder problems and I have successfully initiated and led special clinics for enuresis at various NHS hospitals since 2005. I have been working with GPs and school health nursing teams, both for the management of their patients and guiding and educating the health professionals.

Once a referral is received from your GP/SHN, I will organise a mutually convenient appointment with you and your child face to face at Spire Health Care Centre. I will go through a detailed history in a friendly and non-challenging environment and establish a management plan based on the individual needs of your child.

Most of the children coming to my clinic do not need any special investigations; however, we can organise for an ultrasound of the kidney at the site if required. A very small fraction of children may need a voiding study – this is non-invasive and only involves the child voiding on a special toilet attached with a monitor. This would be organised at a different site in a private setting.

While my initial choice of management always rests on behaviour modification, developing self-motivation and self-esteem, children may need medications short to medium term, especially if the initial measures have failed to produce a response. The choice of treatment is carefully selected based on the history and diagnosis, in liaison with the parents’ and the children’s choices, and all the medications used are very safe with minimal side-effects.

I also provide useful tips and guidance to help your child and also signpost to useful self-help websites.

Your GP/SHN would be constantly involved in sharing the management plan during your journey of care with me.

What should you do to prevent/improve bedwetting?

Regular liquid intake and regular urination are very important to synergise the bladder functions. Your child should be encouraged to drink at least 6-8 glasses of clear liquid each day, and empty their bladder regularly during day time. School health nurses can often provide guidance and help towards this.

Many parents try to lift their child a few hours after going to bed. This is not recommended and can be more disruptive to the child’s sleep. Stopping drinks a few hours before bed, and going to the toilet and good perineal hygiene does help.

Prognosis:

While it is a common problem in young children with a good outlook if managed in a timely manner, it needs to be addressed as soon as possible to avoid becoming a long-term problem and prevent any psychological effects on the child’s development and socialisation needs. It is recommended to manage the condition by seven years of age, after which the long term outlook can be slightly concerning.

Visit Dr Tewary’s Top Doctors profile to book an appointment.