Fiona Le Ber, Queen’s Nurse,Education & Development Coordinator, Family Nursing & Home Care, Jersey, introduces the event.

Fiona Le Ber, Queen’s Nurse, Education & Development Coordinator, Family Nursing & Home Care, Jersey, began the day with the Chair’s opening remarks. She was thrilled to welcome the keynote speaker, Jacqueline Emkes, patient advocate who shared her personal experiences and her national involvement in raising awareness of bladder problems, to improve service provision.

The morning lectures continued with Anna Hancock, Clinical Nurse Specialist for Continence Care at Coventry and Warwickshire Partnership NHS Trust. Anna delivered an engaging and interactive session, testing delegates knowledge on essentials of continence assessment.

Janice Reid, Lecturer in Nursing, School of Nursing, University of Ulster, delivered
an interesting lecture on initial management of continence, including continence disorders and individualised management plans and discussion of first line conservative therapies for common problems affecting both bladder and bowel in adults. Janice explored the need for setting realistic treatment goals within the framework of shared decision making and person-centered care.

The morning session concluded with an insightful update on resources to support continence care, delivered by Nikki Cotterill, Professor of Nursing in Continence Care at the University of the West of England and North Bristol NHS Trust. Nikki highlighted the importance of remembering that each encounter is an opportunity to promote continence, that individuals do not need to be continence experts but need to have the confidence and language to initiate discussions. Nikki explained that enabling disclosure is a priority and signposted to some resources with suggestions about what to do next including:

• The CONfidence app which enables people with bladder or bowel issues to gain information about the causes of bladder and bowel issues, self-help, treatments, products, practical tips and support services. There are additional sections for carers, partners and young people. (www.confidenceapp.uk)

• Continence Product Advisor containment product selection for adults with urinary and/or faecal incontinence. It includes practical considerations for males and females, providing impartial and evidence-based information. (www.continenceproductadvisor.org)

• The bladder & bowel service map highlights the location of adult and children’s services in England by region. The contact and website details for all services are listed. (www.bladderandbowelservicesmap.com)

From the voluntary sector, Nikki highlighted the charities:

• Bladder & Bowel UK (www.bbuk.org.uk)

• Bladder Health UK (www.bladderhealthuk.org)

• ERIC – Children’s bowel and bladder charity (www.eric.org.uk)

Afternoon workshops were delivered and facilitated by committee members with delegates being able to attend all the sessions in small groups.

Karen Irwin, Bladder & Bowel UK, running the puzzle by products workshops.

Karen Irwin, Service Manager / Specialist Nurse, Bladder & Bowel UK, led the ‘Puzzle by Products’ workshops where delegates discussed how introduction of containment products and other resources may help improve quality of life for those experiencing bladder and bowel health issues. They also considered potential challenges faced in selecting appropriate products, including a wide range of toileting aids and equipment that has been designed to enhance incontinence management or assist with toileting. Jenny McCarthy, Clinical Nurse Specialist for the Emerald Nursing Team at B. Braun led a workshop on ‘Demystifying Laxatives’ and Victoria Coghlan, Nurse Consultant Bladder and Bowel, Aneurin Bevan University Health Board led the ‘Catheter Troubleshooting’ workshop

The event received very positive feedback. Delegates were directed to the numerous resources available on the RCN Bladder and Bowel Forum website, including free webinars, informational content, and support materials, accessible here.

The forum also has a closed Facebook page that members can join.

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General suggestions:

Contact the travel company, airline, coach or train operator to discuss your individual needs before booking and travelling. If luggage or body searches are worry as exposure of your continence products is a possibility there might be a private area where this can be done.

Think about what you need to carry with you, such as medicines and spare products. You may need to have a letter from your doctor to be allowed to carry them through security. 

You may want to ask the operator if you can board early, to ensure you have time to get settled with anything you may need during the journey.

Disposable continence pads:

• Disposable pads can take up a lot of space. Consider taking pads that are more absorbent than the ones you usually use, so that you need to take fewer of them. Or you could try smaller pads that take up less space.
• Make sure you get the products you’re going to need well ahead of your travel date.
• A vacuum pack bag can help to reduce the amount of space pads take up in your luggage.
• Consider using other products eg. men could consider using a sheath instead. 
• Would you be able to manage washable products while away? These take up less space.
• Ask your product provider whether they are able to deliver direct to your holiday destination, or send a supply beforehand. But make sure you have a backup your luggage just in case there is a problem and they do not arrive.
• Make sure you have some spare products in your hand luggage in case your main luggage is lost or delayed. You could also divide your pads between your luggage and that of a travelling companion if you’re happy to do so.
• Contact the travel provider to see if there are any luggage restrictions or if continence products are exempt.
• If you are worried about leakage, consider having a chair protector for the journey.
• Consider the climate you are travelling too. Dampness can affect the absorbency of pads and heat can affect the adhesive tapes, for example on sheaths.
• Remember you will have less to bring home with you, as most of the pads will have been used.

Managing Catheters on long journeys:

• Consider having a urinal, such as a uribag, to empty catheter bags into. A travelling companion can then take it to the toilet to empty this for you.
• Make sure that you carry spare catheters, bags and any other equipment you may need with you.
• Ensure you have some spares, in case of delays or cancellations.
• Divide your catheters and supplies between your hand and hold luggage and consider giving some to a travelling companion, in case of luggage delay or loss.
• Have hand sanitizer and wet wipes in case access to a sink and soap is limited.
• You can get a medical validation or travel certificate from your catheter provider. It will explain in different languages why you are carrying catheters and also has a section urging officials to be discrete.
• Consider using ready-to-use hydrophilic catheters if you are travelling in countries with poor water quality.

Accessing the toilet:

• Try to book a seat near the toilet and on an aisle.
• Consider using a pad inside close fitting underwear, in case you cannot get to the toilet quickly enough.
• Think about taking a small bag with wet wipes and spares with you that is easily accessible throughout the flight.
• Be aware that some people find that they are more likely to leak larger amounts of urine when the plane starts to descend. Consider planning a toilet visit just before then.
• If you’re not sure what the toilet facilities are like at your arrival destination, consider a toilet visit before decent begins.

Clothing:

• Wear clothing that is comfortable and easy to rearrange when accessing the toilet.
• Dark coloured clothing makes leaks less visible.
• Loose fitting clothing is easier to remove. 
• Consider having a spare set of clothing and a plastic bag in your hand luggage in case of leaks.

Fluid intake:

• Make sure that you drink enough. Plenty of water will prevent dehydration, help to protect against urinary tract infections and ensure that urine remains dilute. Concentrated urine can irritate the lining of the bladder and increase wetting.
• Avoid tea, coffee, hot chocolate and alcohol as all of these increase urine production.  
• Avoid fizzy drinks as these can irritate the bladder lining.

Bowel issues:

• Try to stick to your usual diet routines when travelling to avoid feeling bloated, nauseous or uncomfortable. Digestion and body clocks can be upset by crossing time zones.
• Try to move as much as you can, particularly on long flights. This will help with both circulation and digestion.
• Discuss with your health care professional whether an enema or suppository a few hours before the flight would be an appropriate way for you to try and avoid a bowel motion during the flight.

Find more Bladder & Bowel UK resources here: Information library for adults – Bladder & Bowel UK (bbuk.org.uk)

Find NHS advice here: https://www.nhs.uk/conditions/urinary-incontinence/

The post Travelling with a continence problem appeared first on Bladder & Bowel UK.

It is thought that that less than 40% of people with urinary incontinence seek help for their condition from a GP or healthcare professional. This figure is even higher for those with faecal incontinence. It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems and 6.5 million adults in the UK suffer with some form of bowel problem (NHS England Excellence in Continence Care 2018).

Bladder and bowel care is fundamental to all holistic nursing and other health professional’s care. It is everyone’s business to identify and provide initial help to those with continence issues. It is not just the remit of those who work and specialise in bladder and bowel services.

For many, bladder and bowels are seen as a taboo subject. This increases the difficulty for professionals, as well as for the public in initiating conversations and in finding the right language. Many professionals may worry about managing the outcome of the discussion, if the subject is broached due to limitations of their knowledge: what is the right information to provide, what are the next steps and where can their patient go for more help and support. These legitimate anxieties together with knowledge gaps may result in patients not being asked about their bowel and bladder health.

Bladder and bowel conditions have a huge impact on all areas of an individual’s life, from self-esteem and wellbeing to quality of life. However, it is important that healthcare professionals let patients know that the conditions that cause bladder and/or bowel issues can be managed, treated and sometimes completely cured with the right support, advice and interventions. Healthcare professionals should therefore encourage individuals to have the initial conversations and avoid self-management or putting up with continence issues. Informing people that that much can be done to treat and improve symptoms and signposting to relevant services is important.

Healthcare professionals are often placed in a privileged and trusted position, where they can take and make opportunities, to speak to people about their bladder and / or bowel, opening conversations or building on information shared about an individual’s continence needs. Making every contact with patients a health promotion opportunity provides key opportunities including, but not limited to pre- and post-natal care, routine health checks, smear or prostate screening.

Setting the scene

So how, as health professionals, do we confidently start that conversation?

• Try to remove the taboo by asking people about their bladder and bowel health
• Be confident when asking questions
• Consider what information is required and what questions should be asked
• Consider what to do with the information once shared
• Know what local services are available for those with bladder and bowel issues and how to access these

.  How do we broach the topic? 

• Do not routinely recommend pads or other disposable continence products. If someone discloses a continence issue – there are many treatments and other forms of management that can stop or lessen the problem.
• ‘Trigger’ conversations can include simply asking people “does your bladder or bowel ever cause you any problems?” Conversations can develop from this.
• Utilise tools which can accessed locally or freely downloaded from the Bladder & Bowel UK website. These are designed to support staff working in any care setting.
• Knowledge will boost confidence – seek out and access training, education and updates on bladder and bowel health and care. This may be provided locally within your place of work, or contact us as Bladder & Bowel UK for further advice on courses, symposiums and bespoke training (BBUK@disabledliving.co.uk).
• Find appropriate patient information that you can share. This includes information on the Bladder & Bowel UK website at and the Bladder & Bowel UK helpline.
• Familiarise yourself with local referral pathways for those patients need specialist treatment or management.
• Understand what is usual and what is not normal – for example, lumps and bumps where they should not be, unexplained bleeding or sudden changes in bladder or bowel habits.
• Choose the right language: terms such as “do you have any problems controlling your bladder” or “do you have any problems going to the toilet” might lead to open dialogue.

Only by understanding and addressing the barriers to open conversation about intimate issues can we remove the stigma surrounding bladder and bowel health and ensure patients get the timely support and treatment they need.

For more information and resources for professionals working with bladder and bowel issues, visit our professionals’ section here.

The post Starting conversations with patients/carers about their bladder and bowel health appeared first on Bladder & Bowel UK.

Historically, continence problems (wetting and soiling) in childhood were thought to be the result of an underlying psychological, emotional, or behavioural problem. A journal article written in 1972 stated that… enuresis has long been considered a sign of emotional disturbance…

We have thankfully come a long way in the last fifty years and have a much better understanding of the causes of wetting and soiling. We now recognize that nearly all children who have these problems have an underlying medical condition, such as constipation. Wetting and soiling often result in distress, psychological, emotional or behavioural problems, rather than being the cause of them. Therefore, the correct treatment will often result in improved mental health and/or behaviour.

Often families will say that their child does not appear to be upset by the wetting or soiling and will deny they have had a wetting or soiling accident. This obviously increases the overall stress within the household. However, it is helpful if families can understand that many children are unaware of the bladder or bowel leakage when it happens. For those that are aware, or who become aware a little later, the denial aspect is a coping mechanism and the way that many children will use to help them manage and deal with the problems they are having.

A number of studies have highlighted the effect that uncontrollable bladder or bowel leaks have on the mental health and well-being of children. Therefore, it is important that families ask their child’s GP, health visitor, school nurse or other healthcare professional for help to resolve the problems.

The belief that any wetting or soiling problems will get better with time, or as the child becomes older is not accurate. Most bladder and bowel issues that cause the problems need active treatment and may get worse with time rather than better. Therefore, families should not delay seeking help.

Research in continence

In 2018 a research team interviewed young people with bladder or bowel problems as part of a study. The young people described some of the emotional issues they were going through daily. Many described how keeping the problem a secret from their peers felt like a burden and described being constantly embarrassed and frustrated that no one appeared to understand what they were going through. One young man described his problems as “not life threatening, but life ruining”. This reflects the emotional impact continence problems can have.

Other research projects have investigated the mental well-being and quality of life of informal caregivers who are looking after a family member with a bladder and/or bowel problem. They found that the mental health and quality of life of many of the carers was negatively affected by the continence issues. Those who contact the Bladder & Bowel UK helpline often relate how stressful the problem is and describe difficulty within the family when there are disagreements about how the issues should be addressed.

Continence problems can affect people of all ages

Incontinence in an elderly person is often the trigger for a move into a care home, as the stress and difficulty caused by the day-to-day issues of caring for an individual with a continence problem is often too much for the family member to bear.

Bladder and/or bowel issues affect individuals of all ages. All those involved in supporting them need to be mindful of how having an ongoing bladder or bowel problem may affect an individual’s mental health and well-being. As well as treating and managing the underlying bladder or bowel problem it is important that affected individuals are treated holistically so any associated stress, anxiety or mental health problems can be addressed. It is also important that health and social care professionals recognize that caring for an individual with a continence problem has an impact on the carer and their wider family. They should be provided with the appropriate advice and support regarding managing the individual’s problems, but also on looking after their own mental health and wellbeing.

Providing the right information and support and ensuring any bladder or bowel health issue has been assessed and the appropriate treatment put in place can go a long way in reducing stress and anxiety and improving mental health. However, it is also important that we create opportunities for affected individuals to discuss any mental health issues, by asking targeted questions in the right way, having a non-judgmental listening ear and signposting to support.

More information and support

Bladder & Bowel UK have lots of information and resources on the website at www.bbuk.org.uk to support people of all ages with bladder and or bowel difficulties.  These are all free to download and print.

Bladder & Bowel UK also have a confidential helpline staffed by specialist children and adult nurses. You can contact us by completing our web form, by email at bbuk@disabledliving.co.uk or by telephone on 0161 214 4591.

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Many children and young people experience bladder problems, but these are often poorly understood. They may be associated with behavioural difficulties or emotional problems but are rarely caused by them. It is more likely that any behaviour and/or emotional issues are the result of the bladder problems. Often these reduce or go away when the underlying bladder issue is treated.

Understanding bladder problems in children and young people

To understand the causes of many bladder problems, it helps to understand how the bladder works. The bladder wall has a layer of muscle in it that should reman relaxed, soft and stretchy while the bladder is filling. There is also a circular ring of muscle at the base of the bladder that should remain contracted (squeezed so it is closed) during bladder filling.

The kidneys are constantly producing urine and it is collected in the bladder.  When the bladder is about half to two thirds full it should start to send messages to the brain to alert the individual that they are going to need to use the toilet. As the bladder continues to fill those signals become stronger. Young children who have not been toilet trained for long, may need the later stronger signals to notice that they need the toilet and are therefore less able to wait to pass urine. However, if the bladder is working correctly, older children will become aware of the signals earlier so have more time to get to the toilet.

When the individual goes to the toilet, a complex control mechanism allows the bladder wall to know it is time for the muscles to tighten and squeeze to push the urine out. At the same time, the circular muscle at the base of the bladder relaxes and opens to allow the urine out.  The bladder can then fully empty before the bladder wall relaxes again and the circular muscle contracts and closes the bottom of the bladder. This mechanism allows us to pass urine in a socially acceptable time and place.

While there are different underlying causes for bladder difficulties in children and young people, for most there is no problem with the way the bladder has been constructed. The most common bladder condition in children and young people is called bladder overactivity.

Children and young people with an overactive bladder often appear to leave it to the last minute to go to the toilet. Adults may understandably perceive this as laziness, naughtiness or the child being too engrossed in what they are doing and leaving it too long.  However, ‘urgency’ to get to the toilet is usually caused by the bladder wall contracting (twitching or tightening) suddenly and unexpectedly before the bladder is full.  This happens with no warning and results in an unexpected and urgent need to get to the toilet. If the circular muscle at the base of the bladder recognises that the bladder wall is tightening, it may respond by relaxing and urine may then leak.

The urgency may be associated with frequency, which is the need to pass urine more than seven times a day in children over four years old . Additionally, children and young people with overactive bladder may have bladders that hold less urine than is expected for their age and physical size. This is because the bladder is used to emptying more frequently than it should, so it is never holding as much as would be expected if the bladder were working well.

Many children and young people who have this problem will ‘dance’, fidget, hold their groin or suddenly crouch and put their heel into their perineum.  They are often unaware of what the are doing and if asked if they need the toilet will usually say no.  They will usually then try to get to the toilet quickly just a few minutes later.   This is because the movements that adults recognise as an indication that the child needs the toilet appear to be subconscious in the child.

Did you know an overactive bladder can occur at night?

Bladder overactivity can occur at night as well as during the day. If it does the child or young person may wake more than once a night to use the toilet. If they are unable to wake to bladder signals they may have bedwetting. Overactive bladder is a common cause of bedwetting.

The reason why an individual has developed overactive bladder may be unclear. It can happen as result of a previous urinary tract infection and it is commonly associated with constipation. However, the problem does not always go away when the urinary tract infection or constipation has been treated.

Many children and young people with bladder issues respond by reducing their fluid intake in the hope that drinking less will make the problem better. Unfortunately, strong urine can irritate the lining of the bladder and make the problem worse. Fizzy drinks and ones with caffeine in can also irritate the lining of the bladder.

Assessments for children and young people

Children and young people who are experiencing problems with bladder leakage, frequency or urgency should be offered an assessment of their bladder and bowels to try to work out the cause of the problem and identify the appropriate treatment for them. If constipation or a urinary tract infection is present, this should be treated.  Ensuring that children are drinking plenty of water-based drinks each day is also helpful for many.  Primary school aged children should be having about 1.5 litres of water-based drinks a day; teenage girls should have about 1.5-2.5litres a day and teenage boys should have about 2-3litres a day. Regular toilet visits may also help. However, many children do need specialist assessment, support and medication.

Where can I find more information?

If you are a young person with a bladder or bowel problem, or parent of a child with an issue, then do speak to the GP or school nurse, who should be able to provide more support or referral to an appropriate service.

For more information about bladder and bowel conditions visit the Bladder & Bowel UK website or our children and young resources page.

For general advice and support please complete our Bladder & Bowel UK confidential helpline enquiries web form.

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For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, you can find advice on bedwetting for teenagers and young adults.

Bedwetting in teenagers and young adults

Bedwetting is a very common problem in children, but is less well known about in teenagers and young adults.  However, many in this age group find it not only embarrassing and distressing, but difficult to deal with.

What causes bedwetting in teenagers and young adults?

Bedwetting is caused by a combination of problems:

• Not being able to reduce the amount of urine that the kidneys produce overnight. A special chemical messenger, called vasopressin, usually gets released at night to tell the kidneys to make less urine than they do during the day. That is why most people can stay dry, even if they sleep for eight or more hours a night. If there is not enough vasopressin, then too much urine will be made during sleep.
• Not being able to hold onto all the urine that is made. This may be because the bladder is not big enough, or not working well enough. If the bladder is too small or gets ‘twitchy’ when it fills then it is more likely to empty overnight, even if the kidneys do reduce the amount of urine they make while the person is asleep
• The brain is unable to wake the person up, when the bladder signals that it needs to empty. Not being able to wake up to bladder signals is the main reason for wetting the bed. People who can wake up to go to the toilet will do so. It is the not being able to wake up that causes the wet bed.

Bedwetting is not your fault. it may be helpful to be aware that, not drinking enough during the day, fizzy drinks, drinks with caffeine in, eating salty or high protein foods just before going to sleep, forgetting to empty your bladder before going to sleep and being constipated, may cause bedwetting tor make it worse.

Why haven’t I grown out of bedwetting?

Some children do grow out of bedwetting. However, this is most likely to happen in younger children who are only wet on a few nights a week. Those who wet every night or most nights are least likely to just get better with time.  Although that does sometimes happen, it is not possible to predict who will just get better with no treatment and who will not.

Is there anything I can do to try and help the bedwetting get better?

There are a few things that you can do to help bedwetting improve. Although you may have already tried these with no success, that does not necessarily mean they will not help now.  So, if you are not already doing them, it is always worth trying to see if they do make any difference:

• Make sure you drink well during the day. Having enough water-based drinks will help your bladder to fill properly and stretch to the size that is should be. It will also help to prevent constipation, which can make bedwetting worse. Teenage girls should be drinking about 1 ½ – 2litres of water-based drinks a day and teenage boys should have about 2 – 2 ½litres per day. This should be divided equally into six to eight drinks with the last drink at least an hour before sleep.
• Avoid fizzy and caffeinated drinks, including energy drinks. These can irritate the bladder and cause it to need to become ‘twitchy’. This can make bedwetting worse.
• Avoid eating in the hour before bed. Particularly avoid salty foods and those that are high in protein. Salt and protein encourage the kidneys to make more urine than usual.
• Make sure you go to the toilet just before you settle to sleep.

I have tried all this and am still having wet nights – what else can I do?

If making changes to your lifestyle have not helped, then contact your healthcare professional and ask for an assessment and some treatment. The most common first-line treatments for bedwetting are an alarm or desmopressin. The alarm works by making a loud noise as soon as you start to wet. This is meant to wake you so that you can go to the toilet.  Over a few weeks most people learn to either sleep through the night without needing to wee, or they learn to wake before they are wet.  Desmopressin is a melt or tablet that tells your kidneys to make less urine while you are asleep and is very effective for some people.

About 40 – 60 % of people do not respond to just one treatment for bedwetting. They may need to use both the alarm and the Desmopressin at the same time. Some also need a medication to help their bladder to hold onto urine better. The medicines usually used are from a group called anticholinergics. Your healthcare professional should be able to discuss the most appropriate treatment(s) with you.

I have used these treatments when I was younger – they didn’t work then

Many teenagers and young people who have previously had treatment for bedwetting that did not work , or that did work but where the wetting started again later may feel frustrated, upset, anxious and as if they will always have this problem. However, as we grow up our bodies change. Therefore, treatments that did not work when you were younger may work well later.  Therefore, you should discuss options with your healthcare professional. You can also ask whether there is a local specialist service that you can be referred to.

Where can I find more information about bedwetting in teenagers?

Bladder & Bowel UK is a national charity. It provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting: Advice for teenagers and young adults appeared first on Bladder & Bowel UK.

You Time To Take Action: World Bedwetting Day 2021

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, you can find advice on bedwetting in children with disabilities. 

What is bedwetting?

Bedwetting is a common childhood problem.  It can affect any child. Bedwetting (sometimes called Nocturnal Enuresis) has a number of different causes. Staying dry at night requires a fine balance between how much urine is produced during sleep and the ability of the bladder to hold all of the urine produced.   If the bladder gets full before morning the child has to be able to wake up to the bladder signals, get up and go to the toilet.  A problem in one or more of those areas can result in the child wetting the bed.

Most children manage to sleep through the night without needing to wake up and pass urine.  This is because they are able to reduce the amount of urine that the kidneys make when they are asleep and their bladders are big enough and work well enough to hold all the wee they do make.

How does bedwetting affect children who have a disability?

Having a learning disability, a physical disability or additional needs does not in itself cause bedwetting. However, bedwetting in children with disabilities affects large numbers of families, and treatment can help to make it better.

Children aged 5 years and older who have a disability, or additional need, who are toilet trained during the day, and who are still wet at night should always be offered help.  Assessments and treatments for bedwetting are available and it is important to understand that children are not able to learn to be dry when they are asleep, in the same way that they learn to use the toilet in the day.

What causes bedwetting in children?

For some children, their bladder is not big enough to hold all the urine they make when they are asleep.  Others have a bladder that is big enough, but it gets ‘twitchy’ and empties before it is full.  Some children are not able to make enough of a chemical messenger called vasopressin.  Vasopressin tells the kidneys to make less wee at night.  If the child is not making enough vasopressin, their kidneys will make much more urine at night than they should, so the bladder will not be able to hold it all.  If they are not able to wake up when their bladder is full, it will empty and the bed will be wet.

Another contributory factor is having a problem with constipation. This is because when children are constipated the bottom part of their bowel (the rectum), which is normally empty, fills up with poo.  The full rectum then squashes against the bladder, giving it no room to fill up with urine.

Children with disabilities and additional needs are more prone to having a problem with constipation than their peers.  Therefore, any child who has a day or night time wetting problem, should always be assessed to exclude constipation as a possible cause.  Constipation is not always easy to diagnose as many children do not have clear symptoms indicating it is present.  However, treatment may help with the bedwetting.

What can we do about bedwetting in children with disabilities?

Fizzy drinks or ones containing caffeine can irritate the bladder.  They can make it more likely to be ‘twitchy’ and therefore cause bedwetting or make it worse.  Not going to the toilet just before settling to sleep, drinking too much before bed or having salty or high protein food before bed can also cause bedwetting.

Things that can help to make bedwetting better:

• Make sure your child goes to the toilet just before they go to sleep
• Encourage your child to drink well during the day. Most school age children should drink about 1.5 litres of water-based drinks a day, divided between six to eight drinks
• Fizzy or caffeinated drinks should be avoided
• Try to stop all drinks and food in the hour before bedtime
• Good bedtime routines and avoiding electronic screens in the hour before bed are important
• Make sure your child is not constipated. Your GP, health visitor or school nurse can provide an assessment and suggest treatment if they are.
• If you use nappies or pull ups for your child at bedtime have a trial of three or four nights without them

If you continue to encounter bedwetting in a child with a disability, ask their GP, health visitor or school nurse about the available treatment options which may be suitable for your child.

Where can I find more information?

Bladder & Bowel UK is a national charity. It provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting in children with disabilities and additional needs appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults.

What is bedwetting?

Bedwetting is also known as ‘enuresis’. It happens when someone passes urine during sleep. Traditionally it was thought to be the result of an emotional or psychological problem and treatment was not considered until children were at least seven years old.

It is now understood that bedwetting happens because of a combination of problems. Children who have bedwetting are unable to wake up when their bladder is full. However, most children do not need to wake up during the night to pass urine. This is because they are able to balance producing less urine during sleep with having a bladder that is working well enough to hold onto the urine they do make until morning. If either or both of these are upset, then the child needs to be able to wake to go to the toilet, in order to stay dry. If they are can not do this, then they will wet.

How common is bedwetting in children under five?

Bedwetting is most common in younger children, with as many as one in five children aged 4 ½ years old having at least occasional wet nights. Children who are only wet on some nights may get better with time, but those who are wet every night or most nights are more likely to continue to have the problem.

When can bedwetting be treated?

Bedwetting is now considered to be a medical issue from a child’s fifth birthday and full assessment and treatment should be available from this age. However, families can ask for basic advice and support before this.

What can families do about bedwetting?

There are several things that families can do to improve bedwetting in children of all ages:

• Encourage your child to drink plenty of water-based drinks each day. These will help the bladder to work well and reduce the likelihood of constipation. (Constipation can cause bedwetting or make it worse)
• Avoid giving your child a drink or food in the last hour before bedtime. Drinks and some foods, particularly those that contain a lot of protein or salt can make the bedwetting worse.
• Have good bedtime routines. These include a regular time for going to sleep, avoiding electronic screens and TV for the last hour before bed and going to the toilet just before settling to sleep.

What else can families do for children under 5 years old who are still wet at night?

Toilet training can help the bladder to mature and to hold urine more effectively. If a child has not been toilet trained, including due to disability, then families can ask for support with this. It is possible that toilet training during the day may result in dry nights, over the following six months.

If children are over two years old and have toilet trained, but are struggling to stay dry and/or clean during the day, their healthcare professional may be able to offer some extra assessment and support. Solving the problem that is causing the daytime issues, may help with the night time wetting as well.

For children who have toilet trained, then a trial of at least two or three nights in a row without pull ups or nappies at night is usually suggested. It is a good idea to use a waterproof mattress protector if nappies are not going to be used. If the child is dry or less wet at night, or if the family can manage, then a longer trial without nappies or pull ups could be tried.

If the child wakes during the night, this may be due to bladder signals, so they should be taken to the toilet. However, children should not be woken during the night to use the toilet, nor should they be taken to the toilet without being woken. Although this may help to keep the bed dry if needed (for example when on holiday) it is no longer thought to be helpful as an intervention for bedwetting.

Where can I find more information?

Bladder & Bowel UK is a national charity that provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action, and contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting in children under five years old appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, we discuss some treatment options for bedwetting.

Treatment for bedwetting

Bedwetting (enuresis) is a recognized as a medical condition in children who are at least five years old and have been toilet trained during the day for six months.  It has a number of different causes. These include not waking up to bladder signals, producing too much urine at night (because the child is not able to make enough vasopressin – a chemical messenger that tells the kidneys to make less urine during sleep), and problems affecting how much urine the bladder can hold. Other factors include constipation, what, when and how much your child drinks, and eating just before going to bed.

Why it is important to treat bedwetting

Children who wet the bed usually sleep through their bladder emptying. However, many of them do have disturbed or restless sleep, which can make them more tired than their peers during the day.  This can affect their behaviour and how they perform at school.  Some children who are wet at night are more anxious about having sleep overs or going on overnight trips with clubs or school.  Some children get upset about wetting the bed.

Things to try at home to help with bedwetting

Most primary aged children should be drinking about 1.5litres of water-based drinks a day.  They should have more than this if they are overweight, very active or if the weather or their environment is hot.  Secondary aged girls should be drinking about 1.5 – 2.5litres a day and boys should have about 2.5 – 3litres a day.

Fizzy drinks and drinks containing caffeine can irritate the bladder lining and so should be avoided.

Drinks and food, particularly those high in protein or salt, just before bed can increase the likelihood of wetting. These should be avoided in the last hour before bed.

Going to the toilet just before sleep and having a consistent bedtime routine can also help.  You can also have a trial for a few nights without disposable pull up pants or nappies, if these are used.

What if these things don’t help?

If you have tried or cannot manage the things mentioned above and the wetting continues, then talk to your child’s healthcare professional.  They should be able to offer an assessment and be able to discuss options for treatment of bedwetting.

The treatment chosen will depend partly on the outcome of the assessment and partly on what you and your child feels is likely to be the best option for you.

The first treatments offered are usually either an alarm or a medication called Desmopressin.

Alarms for bedwetting

Alarms are designed to make a noise and wake your child as soon as your child starts to wet. The child would then get up and go to the toilet before settling back to sleep. Alarms are most effective in children whose bladders are working well and who are able and willing to work with them.

The alarm can take several weeks to work. Signs that the alarm is likely to work include seeing at least one of the following in the first three to four weeks:

• Your child waking to the alarm
• Your child managing to pass some urine in the toilet when they wake
• The wet patches getting smaller
• Your child sleeping for longer before the alarm sounds

If there is no progress in the first three to four weeks, your child’s healthcare professional should be able to discuss options with you.

Desmopressin for bedwetting

Desmopressin is a medicine that can help with bedwetting. It is very like the vasopressin that most people produce to tell the kidneys to make less urine. It works by reducing the amount of urine the kidneys make during sleep.

Desmopressin is available on prescription from the age of five. It is usually given at bedtime or up to an hour before and can work very quickly.  It is a safe medicine to use, but children must not drink for an hour before they have it and for eight hours afterwards (they are usually asleep then).  There is more information on desmopressin in the Bladder & Bowel UK leaflet here.

What if the treatment does not Work?

While there are three main causes for bedwetting (not being able to wake to a full bladder, not being able to reduce the amount of urine made overnight, and the bladder not being able to hold onto the urine that is made) there are other factors that have an effect.  Therefore, one treatment on its own will usually be successful for about 60% of children.  40% of children will need to have more than one treatment for bedwetting to help them overcome it.

If your child is still wetting after trying one treatment, they may be offered a different treatment, either instead of the one they have already tried, or as well as that one.  It is important that you talk to your child’s healthcare professional about other options available if the first treatment has not worked. It is also important to know that a treatment that has not worked the first time you try it, may work later.

Where can I find more information?

Bladder & Bowel UK is a national charity. It provides information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

The post Find out more about treatment for bedwetting appeared first on Bladder & Bowel UK.

Historically, continence problems (wetting and soiling) in childhood were thought to be the result of the child having an underlying psychological or behavioural problem.  Now out-dated research from 1972 found that “enuresis has long been considered a sign of emotional disturbance,” and that most children with soiling have an underlying emotional disorder.

We have thankfully come a long way since then and have a better understanding of both these problems. We now recognize that the majority of wetting and soiling problems in childhood are the result of an underlying medical problem, such as constipation. We are also aware that any behavioural or psychological issues are the result of the wetting and soiling and not the cause of them.

Often parents will report that their child appears to be unbothered by the wetting or soiling and will deny they have had a wetting or soiling accident. This obviously increases the overall stress within the household, but parents need to understand that often the denial aspect is a coping mechanism that many children will use to help them manage and cope with the problems they are having.

Many studies have highlighted the affect wetting and soiling problems have on the mental health and well-being of children and so families should always seek medical advice to help resolve the problems. There is often a mistaken belief that children will ‘grow out’ of any wetting or soiling problems and as a result parents may delay seeking help. However, in many cases the problem will get worse not better with time.

A study carried out in 2018 involving interviewing young people with bladder or bowel problems highlighted some of the emotional issues they were going through. Many struggled to hide their problem from their peers and felt constantly embarrassed and frustrated that non one appeared to understand what they were going through. One young man described his problems as “not life threatening, but life ruining” which reflect the emotional impact continence problems can have.

A recent article in The Guardian looked at the link between mental health and disabilities with people with spinal cord injuries, often resulting in lack of bladder and bowel control, showing a high degree of mental health problems.

Studies have also looked at the mental well-being and quality of life of informal caregivers involved with looking after a family member with a bladder and bowel problem. They found that in many cases caring for a family member with ongoing problems negatively affected the carers quality of life and mental health. Parents we work with often relate how stressful the problem is and can also cause rifts within family members when they disagree how the problems should be managed.

Incontinence in an elderly relative is often the trigger factor for the relative going into a care home as the stress and day to day issues of caring for an individual with a continence problem is often too much for the family member to bear.

Continence problems can affect individuals of all ages and we need to be mindful of how having an ongoing bladder or bowel problem can have an affect on an individual’s mental health and well-being. As well as treating and managing the underlying bladder or bowel problem it is important that affected individuals are treated holistically so any associated stress and anxiety can be addressed. We must also recognize how caring for an individual with a continence problem can affect some individuals and families should be provided with the appropriate advice and support regarding managing the individual’s problems.

Providing the right information and support and ensuring any wetting and soiling problem has been assessed and the appropriate treatment put in place can go a long way in reducing stress and anxiety. However, it is also important that we create opportunities for affected individuals to discuss any mental health issues, by asking questions in the right way and having a non-judgmental listening ear.

Bladder & Bowel UK have lots of information and resources on the website at www.bbuk.org.uk to support people of all ages with bladder and or bowel difficulties.  These are all free to download and print.

Bladder & Bowel UK also have a confidential helpline staffed by children and adult nurses who are specialists in bladder and bowel care. You can contact them by email at bbuk@disabledliving.co.uk or by telephone on 0161 214 4591.

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