Bedwetting in children: your questions answered by a paediatric urologist

Bedwetting and other children’s continence problems are not uncommon. In the UK, an estimated 900,000 (or 1 in 12) five to 19-year-olds suffer from bowel and bladder conditions. These include bedwetting, daytime wetting, constipation and soiling. Most bowel and bladder problems are avoidable and treatable, yet it’s estimated that only 11% of those affected ask for help.

Miss Marie-Klaire Farrugia is a paediatric urologist and here she answers the common questions that parents ask her in the clinic when it comes to their child and bedwetting.
 

At what age should my child be dry at night?

Every child is different and there is no rule. However, the International Children’s Continence Society (ICCS) does not consider wetting below the age of five years is abnormal. The recommendation is that: “general advice should be given to all bedwetting children, but active treatment should usually not be started before the age of six years.”
 

What are the causes of bedwetting?

This depends on whether bedwetting is isolated (monosymptomatic enuresis), e.g, the child has a normal voiding pattern and is dry in the day, or whether it is part of a daytime and nighttime problem. Isolated bedwetting involves an imbalance between bladder volume and urine production at night, compounded by high arousal thresholds.

The child often wets the bed in the early hours of the morning and sleeps through it. Combined daytime symptoms, such as frequent accidents, going to the toilet very often, last-minute dashes to the toilet, inability to control the bladder, and bedwetting are a result of “dysfunctional voiding” also known as “bladder overactivity.” This is where the bladder muscle contracts erratically and is difficult to control. The child often wets the bed soon after falling asleep and sometimes more than once a night.
 

Do bedwetting alarms work?

Yes, they do! They work best in children who want to be dry and are ready to work at it, and in those who wet once in the night, usually in the early hours of the morning. The initial “drip” makes the alarm (or vibration) go off and allows the child to wake up and go to the toilet.

Unfortunately, children often sleep through the whole event, but they’re worth a try, especially in older children. You can find a list of alarms here.
 

Does bedwetting get better without treatment?

It certainly does – as long as the basics are adhered to! Follow the link below to learn more about the appropriate fluid volume and timing in each age group, toileting habits and managing constipation. Conservative management should be tried for at least six weeks before progressing to medical treatment.
 

What medical treatment is available?

The initial medical treatment will depend on the sub-type of wetting, which the specialist will determine.

Desmopressin (Desmomelt) is sometimes prescribed for children over five years of age who wet the bed. When we go to sleep, we normally make more of a hormone called vasopressin. This hormone has an antidiuretic effect. That is, it tells the kidneys to make less urine while we are asleep.

Some children do not produce enough vasopressin. These children make almost as much urine during the night as they do during the day and because of this, the bladder is full before the morning. The child then has to wake up and go to the toilet or, if they are not able to wake up to the full bladder signals, as is the case for most children, their beds get wet while they are asleep. Combined treatment with Desmopressin and bedwetting alarms has shown good results in clinical studies. Desmomelt is usually prescribed in three-month courses until the symptoms subside.

If the bedwetting is associated with day-time symptoms, a different course of action may be advised. In this situation, a medicine which acts on the bladder muscle, known as anti-cholinergic (such as Oxybutynin and Tolterodine), may be prescribed.

Anticholinergics “calm” the bladder muscle and reduce urinary frequency, or urgency and urge incontinence. Over a prolonged course (at least four weeks), the medication will also improve bladder “compliance.” This is the ability of the bladder to stretch and grow in response to appropriate fluid intake.
 

How long will it take for my child to be dry?

This depends on a number of factors including how much the child wants to be dry, and if the basics are adherent too. Some children will become dry without medical treatment. Others may need support for a few months. On rare occasions, the problem persists, but other strategies are available.



You can book an appointment to see Miss Farrugia now via her Top Doctor’s profile here if you are worried about your child’s bedwetting and would like an expert opinion.