Bedwetting (Nocturnal Enuresis)

Bedwetting is nobody's fault. It is something over which the child has no control.
Bedwetting is a common experience and although there are various causes, the major effects remain the same: distress, embarrassment, shame and feelings of worthlessness.
Normal bladder development for dryness at night is 4 to 6 years of age. Development of bladder control varies in the same way as other areas of development, eg. crawling and walking.
Bedwetting is common 

In a school class of 30 children:

  • At the age of five, there will be five or more children in the class who are still wetting the bed at least twice a week;
  • At the age of seven, there will be two in the class who are still wetting the bed at least twice a week;
  • At the age of ten there will be one or two;
  • In the first year of high school there will be one; and
  • In year 10 (15 year olds) there will be one in every two classes.
Why does bedwetting happen?

There is no single reason, however, there are contributing factors:

  • In most cases there is a family history of bedwetting. If both parents were bedwetters then there is a three out of four chance their child will also be a bedwetter;
  • It may be due to delayed control of the bladder muscle. Children learn to become dry at different ages in the same way as they learn to talk, crawl and walk at different ages.

Help can be sought when the child is old enough to see the wetting as a problem and take on the responsibility of wanting to do something about it. This varies from child to child, but generally it will occur around the age of 6 years. It is the child's problem and no matter how much others may want the child to become dry, it is the child who needs to be motivated to change.

What are the management options?

Management of enuresis is dependent on the developmental stage and motivation of the child and the support and commitment of the family. Options include:

  • Education of the child, parent and others. Suggested reading - 'How You Can Be Boss of the Bladder' by Doctor Janet Hall;
  • Bladder Training Program - the child needs to be taught good bladder habits to increase their bladder capacity and their bladder control;
  • Bed wetting alarms are widely used and are considered to be the most effective and safe method of management. To be successful, it is advisable the alarm method only be used within a supervised self-management program using reliable machines of the highest quality;
  • Behavioural Program - this method of management can be used by itself but it can also be used with the bedwetting alarm. Motivational strategies, positive practices and positive reinforcements are just some of the many behavioural approaches; and
  • Medication - these can only be prescribed by a doctor. Generally, these are not used as the first line of management.

Counselling and support will enable the best possible chance for a succesful outcome.

References:

Hall J (1997) 'How you can be boss of the bladder'

Farish Kaye 'Bladder Works' pamphlet, Farish Bissell Ind. Pty. Ltd

Harkness Chris (1997) 'Bedwetting Treatment Manual for Nurses'

Recommended Resources
  • Wetaway Pamphlet
  • Parent Information Flyer

Booklets

  • The Dry Night
  • Sleepover
  • Watertight (these booklets are currently out of print, published by the Continence Foundation)

Suggested Readings

  • Easy Toilet Training - Janet Hall
  • How to be Boss of your Bladder - Janet Hall
  • Bedwetting - Manual for Parents - Jan Mathews

Videos

  • Kaye Farrish - Think Dry
  • Ramsey-Coote - The Way to a Dry Bed
What can parents do to help children?
  • Encourage your child to drink regularly through out the day, starting at breakfast (5 to 6 drinks daily);
  • Do not restrict fluids as this may stop the bladder from increasing in size and holding more urine;
  • Water is the healthies drink, avoid sweet and fizzy drinks and drinks containing caffeine as these can irritate the bladder causing more frequent emptying;
  • Avoid lifting the child onto the toilet at night. This teaches him/her to pass urine while asleep. It also prevents normal bladder function;
  • Do not punish or scold the child or blame yourself;
  • Provide a healthy choice of foods limiting foods high in sugar, take-aways and processed foods;
  • Avoid constipation as this interferes with normal bladder function;
  • Reduce or eliminate any fears around toileting;
  • Don't reward dry nights as your child has no control over this;
  • Avoid frequent toileting as this interferes with the recognition of a full bladder;
  • Some children's bladders don't hold as much urine as other children. They have a smaller bladder capacity - this can be increased; and
  • Other contributing factors are emotional, physical illness and stress.
What effect does bedwetting have on children and their families?

Bedwetting is a symptom, not a disease, which causes stress for both children and parents.

Persistent bedwetting can lead to:

  • Loss of self-esteem and lack of confidence in the child - possibly becoming withdrawn, having difficulty making or keeping friends or underachieving at school;
  • The child opting out of social activities that require overnight stays;
  • Parents feeling anxious, guilty and eventually experiencing loss of confidence in their parenting skills; and
  • Difficulties in relationships between parents and child and conflicts within the family.

It is recommended families seek help rather than thinking, 'they will grow out of it', some never do!

For more information contact your local Child Health Centre or the Wetaway Program