Help for the children who don’t grow out of bedwetting
TEN years after her friends had moved their children out of nappies at night, Linda Watson was still having to strip her son’s and daughter’s wet sheets most mornings. Her son Jake, now 18, and daughter Lucy, 16, wet their beds until their early teens.
‘It happened five nights a week,’ recalls Linda, 55, a solicitor, from Essex. ‘I’d get up at 5.45am, strip two beds and put on the washing machine before breakfast. It became part of our morning routine.’
For Lucy, it became a particular problem when she was invited to Guide camps or sleepovers at friends’ houses. ‘Lucy would have to take extra clothing and disposable nappy pants to wear at night.’
When Lucy was six and Jake eight, the family saw the doctor and school nurse, but were told the problem would just resolve itself.
On their advice, Linda tried everything from cutting down on drinks before bedtime, to medication. All to no avail.
Bedwetting, or nocturnal enuresis as it is known medically, affects both children and adults. Eight per cent of children aged nine still wet the bed, according to a 2008 study of 14,000 British children. Most grow out of it, but one in 100 adults is affected for life, according to the Bladder and Bowel Foundation.
It can have a devastating impact on self-esteem, performance at school and work and social activities.
‘Young people often miss out on opportunities such as sleepovers and school trips and start to feel “different” when they realise their friends have stopped wetting the bed,’ explains Brenda Cheer, of children’s continence charity ERIC.
Last October, the International Children’s Continence Society (ICCS) and the European Society of Paediatric Urologists (ESPU) launched World Bedwetting Day to raise awareness that bedwetting is a common medical condition with the potential to cause behavioural or psychological problems.
Bedwetting is more common among boys than girls and often runs in families — a child with one parent who was a bedwetter as a child has a 44 per cent chance of being a bedwetter themselves, compared with 15 per cent when there is no family history.
And if both parents were bedwetters, that rises to 77 per cent, according to research published in the Journal of the American Academy of Child and Adolescent Psychiatry.
Bedwetting is often caused by the body failing to produce enough of the hormone vasopressin at night, says Nick Madden, vice chair of the Paedi- atric Continence Forum and a retired consultant paediatric urologist.
This hormone, produced by the pituitary gland in the brain, controls urine production in the kidney. Normally, more is produced at night so we are less likely to need the loo in the night.
Night- time production of vasopressin usually kicks in by the age of five. But in many bedwetters, not enough vasopressin is produced, so urine production continues as normal. This may be down to a genetic fault.
Another cause is an overactive bladder — where the bladder spasms when it is slightly full — or the bladder may hold a smaller volume of urine before sending a signal to the brain that it needs to be emptied.
In other cases, the body’s messaging system — which sends signals from the bladder to the brain when it is full — is not fully developed. Bedwetting is also more common in people who are difficult to rouse from sleep.
‘Often it is a combination of these factors,’ adds Mr Madden.
If bedwetting starts suddenly (secondary nocturnal enuresis), it is usually a sign of another underlying conditions such as constipation, urinary tract infection, diabetes, nerve, prostate or muscle problems or emotional upset or abuse.
Paediatric specialist continence nurse Brenda Cheer says many children can be helped simply by giving them a laxative.
‘If you’re constipated, the lower bowel is full and occupies some of the bladder’s space, reducing the amount of urine it can hold,’ she says.
Urinary tract infections can be another cause, she says, because the infection irritates the bladder.
‘If the wee is cloudy or smelly, get it checked by the GP,’ she says. ‘And make sure the child drinks enough fluid — six to eight drinks a day, spread out over the day — or the bladder won’t be used to holding urine, and will be more prone to leaking during the night.’
Some drinks can irritate the bladder or increase urine production, however, so bedwetters should avoid caffeinated drinks, blackcurrant or orange drinks (they irritate the bladder in some children), and those with artificial colours or sweetener.
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tips include stopping drinking an hour before bedtime.
If simple measures are ineffective, treatment includes bedwetting alarms. These contain a sensor that detects when the wearer is starting to wet the bed and the alarm wakes them up. This is meant to teach them to be more sensitive to bedwetting.
The drug desmopressin — a synthetic version of the hormone vasopressin — taken just before bed can stop the kidneys producing as much urine at night.
However, many bedwetters are too embarrassed to seek help from their GP.
Fortunately, both Lucy and Jake stopped wetting the bed regularly at the age of 13 — their mother now wonders if genetics played a part, and that it took longer than usual for the proper production of vasopressin to kick in.