Incontinence (leakage of wee or poo), difficulties with toilet training, or other issues with toileting can result in difficulties at home, nursery, school or in the wider community. They are a source of stress and frustration for families, not only due to the difficulties of practical management of ‘accidents’, but also because of the impact on your child.  

Children who are struggling with learning the skills required for toilet training, or who have toilet trained but have new or continuing wetting or soiling (urinary or faecal incontinence) are often embarrassed and upset about the problem. However, some children will behave as if they do not care about an issue that they cannot control. This may make you feel the wetting or soiling is deliberate, laziness, or naughty behaviour. This is very rarely the case. Childhood incontinence, or issues such as appearing to leave it to the last minute to go to the toilet, is nearly always caused by a bladder and/or bowel health problem. Most of these can be successfully treated. 

Wetting and/or soiling in children and young people may be associated with emotional problems, difficulties with mental health, poor self-esteem and reduced social opportunities. Furthermore, the additional washing and clothing needed may be expensive. Therefore, it’s important you know where to turn for more help and information.  

In this blog post, we outline what you should be able to expect from the different professionals who may work with you and your children within health or education.  

Nursery

Nurseries should ensure that all children in their care are kept safe and supported to learn and develop according to their individual needs. This includes providing support for bladder and bowel health. 

• It is reasonable to expect nursery to support the needs of your child, as an individual, whilst in their care and review this support regularly.  
• Staff at nursery should be trained in supporting you and your child with learning the skills that they need to be successful with toilet training. You should not be expected to wait until a particular age for this. 
• Healthcare professionals can train nursery staff to complete any procedures your child needs for their bladder or bowel health e.g. catheterisation. 
• If nursery identify a cause for concern, they should discuss this with you and suggest that you contact your local GP or health visitor for further assessment, advice, and support.  

Health visitors

Health visitors are qualified nurses that sit under the umbrella of universal services. This means they should be available to all families with children who have not yet started full time primary school. They work to identify health needs as early as possible and to improve young children’s health. Your health visitor should meet you when your baby is about ten days old. They will see you either at home, in a local child health clinic, or at your GP surgery. 

• Health visitors should be trained in children’s bladder and bowel health and assessment of any possible issues.  
• Health visitors are often the first point of contact for assessment and guidance of your child’s bladder and bowel issues.
• It is reasonable for these health professionals to discuss your child’s bladder and/or bowel issues with their GP. They may also, with your consent, talk to other professionals supporting you with your child e.g. social worker or family support worker or other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options.

School nurses

School nurses are trained nurses that are also part of universal services and work with children aged 5 -19 years old. They work in schools and other settings to promote health, identify health needs and offer suggestions to prevent health issues getting worse. They can also refer to other services as required. School should be able to provide you with information about how to contact your school nurse.  

• School nurses should be trained in children’s bladder and bowel health and assessment of any issues. 
• You can contact your child’s school nurse if you have any concerns about your child’s bladder and/or bowel. 
• If your child is at secondary school, they may be able to ask to see the school nurse at a regular ‘drop-in’. They do not have to say why they want to see the school nurse.  
• They should be able to offer initial assessment and suggestions to help. 
• The school nurse may discuss your child’s bladder and/or bowel health with their GP. They may also ask your consent to talk to other professionals who are supporting your child e.g. social worker, family support worker, other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and  your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

General Practitioners

General Practitioners (GPs) are doctors who treat common medical conditions and can also refer on for more specialist advice and treatment if this is required.  

• You can contact your GP if you have concerns about any aspect of your child’s bladder and or bowel health. You do not have to have seen a health visitor or school nurse first. 
• Your GP will review any assessments completed by your child’s health visitor or school nurse, if you have already spoken to them, and discuss with treatment options and provide general lifestyle advice to help. 
• It is reasonable to expect that they may wish to complete a face-to-face physical assessment of your child. This may include examining their tummy or asking for a urine or stool sample.   
• Dependent on your child’s condition and/or progress they may refer your child for further assessment and treatment with another health professional in a specialist service. This can be a specialist nurse, therapist or paediatrician. Referrals may take some time as many services are very busy and have long waiting times. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

School or collage

Schools or colleges are often able to identify health concerns in children and young people. They should discuss any such concerns with you and they may also ask the school nurse for support and advice.  

Schools have a duty to support children and young people with medical conditions. There is more information about what you can expect from school if your child has a bladder or bowel issue in the guidance: Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges.

• Professionals in school such as your child’s teachers, teaching assistants, special educational needs coordinator (SENCO) may raise any concerns with you.  
• Education staff may ask for the school nurse to contact you and request consent to assess your child or they may ask you to contact the school nurse or your GP, and, as appropriate, seek further advice from your GP regarding your child’s continence. 
• Schools must make reasonable adjustments to meet your child’s bladder and bowel needs whilst they are in their care. This includes during school trips and sports sessions 
• Schools should provide safe, clean, and accessible toilet facilities for your child. They should allow them access to these as required. 
• Schools should allow children and young people to drink water regularly during the day, to ensure they stay well hydrated.
• It is reasonable to expect that school will discuss a care plan for your child with you and with your child if this is appropriate for their age and development. 
• School may request that other professionals involved in your child’s care contribute to any care plan to ensure that your child’s needs are met, and difficulties addressed promptly. 
• School may request support and training from a specialist team, if they are involved with your child’s care and your child needs support for interventions that need to be carried out in school e.g. catheterisation or stoma care. 
• Schools should be able to make suggestions about where you can get further information and support about your child’s bladder and/or bowel issue.  

Specialist services

Specialist services for children and young people’s bladder and bowel health vary across the UK. Some areas have a nurse-led, community-based children’s bladder and bowel service. Where these are not available your child may be referred to a paediatrician at their local hospital, if it is felt that a specialist service is needed.  

• A specialist service will assess your child’s bladder and bowel health. It is likely this will involve asking lots of questions about their general health and usual bladder and bowel habits. You may be asked to complete some forms that include information about their drinking and toileting patterns.  
• The service should explain what they think is causing any bladder and/or bowel issues and may provide written information about this and any treatment suggestions. 
• The specialist service may make suggestions about drinking and toileting routines and other lifestyle adjustments that may help. They may also recommend other treatments. 
• The service should offer regular reviews and treatment adjustments after discussion with you and your child (depending on their age and level of understanding) until the bladder and/or bowel issue has resolved.  
• Some children may require onward referral for further investigations and treatment options. Reasons why this may be recommended should be discussed with you and your child if required.  

Further information

There is more information about children’s bladder and bowel health and problems on the Bladder & Bowel UK website.

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Transanal irrigation (TAI) is a management option for people who suffer from constipation. Here, we look at best practice for those who are using TAI for constipation to make sure it is as safe, comfortable and effective as possible.  Remember, it is always best to discuss the issue and any treatment with your doctor.

How do I get the best results from transanal irrigation?

Before commencing irrigation, it is advisable to familiarise yourself with your irrigation system.
Following the provided instructions for use, assemble the product, fill with water and pump
through the system.

It can take a little time to get used to irrigating, and for the bowel to become accustomed to the
procedure. It may take 2–4 weeks to get into a well-practiced routine. It is important to irrigate at a
similar time each day and to allow yourself enough time to complete the procedure thoroughly.
The process takes approximately 20-35 minutes and should be performed regularly (usually every 24 or 48 hours) to achieve the best results.

For those with reduced, or no bowel/rectal sensation, it is advisable to stay close to the toilet
post-irrigation, until you have a routine that works well for you. It is a good idea to use a disposable absorbent pad immediately after performing irrigation.

You can repeat the irrigation process if required. If you are unable to feel the urge to open your bowels, then you can use measured of amounts of water to achieve the right volume for you. It is best that you speak to your clinician to discuss what is right for you.

As irrigation cleans the lower portion of the large intestine it can help to:

• Reduce the risk of constipation by preventing the build up of stools
• Reduce the risk of faecal incontinence and leakage in-between each evacuation
• Regain control over your bowel management
• Reduce the amount of time spent on your bowel care

This article is part of the Education Spotlight on Constipation, supported by Renew Medical. You can also read more about constipation in our information library here.

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Constipation is common, but there are management options that can help. Here we take a look at how transanal irrigation helped one teenager manage his condition.

Rugby-playing Joe, 14, suffers from idiopathic constipation, a type of constipation where the cause is unknown. An estimated 1 in 100 children and young people suffer from the condition. Symptoms include painful bowel movements and bowel movements that are hard, or difficult to pass . Sufferers may also soil their underwear, which is something Joe is particularly familiar with, experiencing ‘accidents’ between 8 and 12 times a day.

According to Michael, Joe’s father, Joe has struggled to control his bowel movements all his life. At primary school he had to take a nappy sack in with him, along with clean underwear to change into. It wasn’t until he was eight that he was diagnosed with idiopathic constipation, but even then, the process was long and often fraught. ‘It was overwhelming,’ Michael says, particularly as the initial treatment Joe was prescribed ‘made (the condition) a lot worse.’

While Joe – an otherwise typical teenager – has a laissez-faire attitude toward it all, describing these years as “a bit of a pain,” his father is more outspoken about the anxiety and stress it had on the family. “It’s been a weight on my mind,” he says. ‘I’ve been climbing the walls.’

Joe, too, admits that his insecurities growing up often prevented him doing the things he wanted to do, such as staying over at a friends house.

“He’s growing up and getting older now,” Michael says. “There’s a lot more self-consciousness and body shaming happening. He got self-­conscious that someone might pick up on an accident he wasn’t aware of.”

Help with managing constipation

Things changed around six months ago when Joe’s doctor suggested transanal irrigation (TAI).  TAI is a simple procedure in which body temperature water is passed through a soft silicone cone or a catheter into the rectum, to assist in the safe evacuation of stool from the lower section of the bowel.  

Though Joe was already familiar with using suppositories, he hadn’t used TAI before and he initially worried it might be uncomfortable or difficult to use. “I wasn’t sure about it at first,” he says. But to his surprise, he found the system soft and comfortable. “It doesn’t hurt at all,” he says.

Now, Joe uses an irrigation system every morning before school. It takes him between ten and twenty minutes, and he passes the time watching a show on his iPad. In the evening, he takes a laxative treatment.

“A dramatic change.”

Michael remembers the day he started his new regime. ”He came home from school and there was an actual swagger in the way he walked. That sense of relief, you know?”, he says. Joe says he feels a lot more sociable now. He’s also confident enough to enjoy rugby and other contact sports without the fear of an accident.

“His sport and social life have changed dramatically,” Michael says. “It’s really made a tremendous difference. It’s improved things vastly.”

“It really has helped,” Joe agrees. “I’m not worrying about anything now. It’s great!”

This article is part of the Education Spotlight on Constipation, supported by Renew Medical. You can also read more about constipation in our information library here.

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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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At Bladder & Bowel UK we are frequently asked questions about the role of water for children with bladder and/or bowel conditions, as well as how to encourage reluctant children to drink the right amount of water for their age, size and activity levels.  We have written and are publishing this blog to help professionals, children, young people and families as part of Nutrition and Hydration Week 2021.

Encouraging children to drink more water

Adequate fluid intake is important for maintaining health and wellbeing. There is guidance for how much water children of different ages and genders should be drinking.

Suggested intake of water-based drinks per 24 hours by age and gender
(Adapted from CG 111 Nocturnal Enuresis NICE 2010 and American dietary requirements, cited in CG 99 Constipation in Children and Young People, NICE 2010).

Children will need more than this if they are physically active, if the weather or classroom is hot, or if they are overweight.

However, many parents complain that their children are reluctant to drink and say they do not feel thirsty, or they refuse to drink water.  Not drinking enough can cause or exacerbate constipation and bladder problems including urinary tract infections, day and night time wetting, as well as being the reason for headaches, feeling tired and struggling to concentrate.

What type of fluids should my child be drinking?

Water is the best drink, as it does not contain any sugar or other additives. However, some children refuse to drink water.  If this is the case for your child, you could try the following:

• Offer them water from the fridge or add ice cubes to it
• Use very dilute sugar-free fruit squashes as an alternative

There are also some things that are not advised. These include:

• Not offering your child fizzy drinks as an alternative to water, except as a rare treat. Fizzy drinks can irritate the bladder lining. This may make your child need to rush to get to the toilet or they may need to go to the toilet more often than is usual.
• Avoid giving your child drinks with caffeine in them. Caffeine can also irritate the bladder causing the same issues as fizzy drinks – having to get to the toilet in a hurry and needing to go more frequently than is usual.
• Not letting your child have more than 500mls (one pint) of milk per day. While milk is healthy, the body uses it more as a food than as a drink.  Additionally, too much milk can exacerbate or cause constipation and may contribute to excessive weight gain.

How can I encourage my child to drink more water-based drinks?

Encouraging children to drink may be difficult, especially if they do not feel thirsty. However, thirst is quite a late sign of needing fluids, so children should be drinking regularly. They should have about six to eight drinks spread evenly throughout the day.  They should be having about half of their drinks during the school day.

Things that may encourage them to drink more include:

• Build drink times into your family’s routine.
• Make drink times fun: sitting together with a book or game and only read the next page or have your turn at the game when your child has had a few more sips. If your child refuses to  drink then put away the book or game until the next drink time.
• Let your child chose their glass, cup or straw. Novelty straws work well for some children.
• You could offer them ice cubes or add slices of fruit to water.
• Start by expecting your child to drink only slightly more than they currently are and then gradually increase the amount you expect them to have until they are having about 1.5litres per day.
• Some children manage better if given half a glass and told to drink it all; others do better if given a full glass and are asked to drink half of it.
• Measure out your child’s water into a clean jug or plastic bottle each day, so they can see what they should be drinking. Pour all their drinks from that so they can see how well they are doing and offer them a small reward if they manage to drink it all.
• Ice lollies and jellies have high water content, but try to chose ones that are sugar-free.
• Do not have battles over drinks.

How can I encourage my child to drink more when at school?

There is information about bladder and bowel issues in nurseries, schools and colleges on the Bladder & Bowel UK website at https://www.bbuk.org.uk/wp-content/uploads/2021/01/Managing-Continence-Problems-in-Schools-2019-.pdf. This includes information for schools on why it is important for children to be drinking well during the school day.

Other things that may help include:

• Ensure your child always has a sports bottle of water for school each day. Make sure they bring the bottle home at the end of the day and offer them a small reward for drinking most or all of it.
• If your child enjoys cold drinks, almost fill the water bottle and put it in the freezer overnight. The water will stay cold as it melts at school the next day.
• Ask the teacher to build drink times into the day, or to allow the children to have their water bottles on their desks.
• Ask the teacher to allow the children to have their water bottles on their desks whenever possible and to use the toilet when they need to. If your child thinks they will not be allowed to go to the toilet, they might not drink at school.
• Encourage secondary age children to drink when moving between classrooms, unless this is not allowed in their school.

Other things to consider

Do not encourage your child to drink in the hour before they go to bed as this may cause bedwetting or make it worse.  If your child has a bladder or bowel problem, making sure they drink the right amount during the day can help (see the chart above).   A good fluid intake can also help when toilet training.

Where can I get further advice or support?

If you are worried that your child may have constipation, or if they have day or night time wetting, if they are struggling with toilet training, or you have any other concerns about their health speak to their GP, school nurse or health visitor for more advice.

There is also lots of information about bladder and bowel conditions in children on the Bladder & Bowel UK website on the Children Resources page.

Bladder & Bowel UK also offer a free confidential helpline for anyone affected by bladder and bowel issues. Contact us via our enquiries web form and a member of the team will be in touch.

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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.

What is World Bedwetting Day and why is it important?

World Bedwetting Day was launched by the International Children’s Continence Society and the European Society for Paediatric Urology in 2015. The aim is to raise awareness of bedwetting and its impact on children, young people and their families. Bedwetting is not a trivial condition and not all children get better with time. Those children who are wet five or more nights a week are least likely to get better without treatment. Bedwetting continues to affect about 1 – 3% of teenagers and 0.5 – 1% of adults.

What is bedwetting?

Bedwetting, also known as enuresis or nocturnal enuresis, is the condition of wetting the bed during sleep. It is a recognised medical problem in children who are at least five years old and have been toilet trained during the day.

What causes bedwetting?

It used to be thought that it is a straight-forward condition that would get better on its own, in time. However, it is now known that it can be a complex disorder, which has several different causes.

Bedwetting is not caused by a psychological problem or stress, although these may make bedwetting worse and can arise because of the bedwetting.

• Bedwetting is caused by a combination of:
• The kidneys making too much urine overnight.
• The bladder being too small or not working well enough to be able to hold the urine made at night.
• The affected child or adult not being able to wake up to the messages from the bladder to the brain saying that the bladder needs to empty.

Are there any other problems associated with bedwetting?

Many younger children and their families are not concerned about bedwetting.  However, as children become more socially aware, they can become upset by it. It can affect their self-confidence and self-esteem and their emotional wellbeing. Although children do not wake up when they need to empty their bladder, the messages from the bladder may disturb their sleep, and so have an impact on their day-to-day functioning, including their school performance.

Bedwetting can also be stressful for families. However, it is important to remember that bedwetting is not due to anything you or your child has or has not done. It is a medical condition and not anyone’s fault.

Should we ask for help?

Successful treatment improves brain and psychological functioning, reduces problems with sleep and behaviour, improves self-esteem and reduces stress and embarrassment.  Active treatment, with an alarm or medication, can be offered from five years old with initial lifestyle advice being helpful for many children, including those who have not yet reached their fifth birthday.

Where can we get help and advice?

Your child’s healthcare professional (health visitor, school nurse, or GP) should be able to provide initial advice and support. If the bedwetting does not improve with some simple lifestyle adjustments, then they may be able to discuss options with you or refer you to a local clinic for further assessment and treatment.

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.

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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. In this blog post, we discuss the important facts of bedwetting. 

What is bedwetting?

Bedwetting is the leakage of urine during sleep. It is also known as enuresis or nocturnal enuresis and is a recognised medical condition. To be diagnosed with bedwetting the person affected must be over five years old. However, support and basic advice for bedwetting is available to families of younger children who are toilet trained in the day.

Does bedwetting get better with time?

Some children will ‘grow out’ of bedwetting. However, not only is it difficult to predict who will get better if no treatment is offered, but it is also not possible to say when the wetting will stop.  There is evidence that children who are wet every night, or most nights are the ones who are least likely to just get better without treatment.

How many children are affected by bedwetting?

The numbers of children with bedwetting does reduce as the children get older.  21% of  four-and-a-half-year-olds are wet less than two nights a week, and 8% are wet more than two nights a week.  At nine-and-a-half years old, about 8% are wetting the bed less than two nights a week and 1 ½% are wet more than two nights a week.

Does bedwetting affect older children and adults?

Bedwetting is not just a problem for younger children. ‘Primary enuresis’, which is the medical term given to bedwetting that has continued since toilet training, affects about 3% of adolescents and about ½ – 1% of adults.

What might become a problem after dry nights?

If bedwetting starts after a child, has been dry at night for at least six months, it is called ‘secondary enuresis’.  Sometimes there is an obvious trigger for this, like a urinary tract infection, but sometimes it is not possible to work out why it has started.   Rarely, there may also be an underlying medical issue, which needs treatment. That is why it is important to discuss any new bedwetting with a healthcare professional.

Is bedwetting a normal part of growing up?

Children cannot learn to be dry at night in the same way as they do during the day. To become dry at night the kidneys have to be able to reduce overnight urine production and the bladder has to be large enough and work well enough to be able to hold all the urine made at night. If these are not happening, the child has to be able to wake to the bladder signals and go to the toilet if they are to stay dry. Many children are not able to do this, so they get wet during sleep.

What treatment options are there for bedwetting?

If there is any constipation this will usually be treated first. That is because a constipated bowel can put pressure on the bladder and cause bedwetting. Daytime problems, such as dampness, wetting, having to get to the toilet in a hurry or using the toilet very frequently should also be addressed as these can affect how the bladder works at night. Many children will be asked to adjust their fluid intake and toileting habits to see if these help. Some children may need medication to treat daytime wetting.

If none of the above help, or if they are not needed, the first treatments offered will usually be either an alarm or a medicine called Desmopressin. Your Healthcare professional will talk to you about the options and help you and your child chose which treatment to try first.

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, 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 and a member of the team will get back to you.

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

The post Bedwetting: The facts appeared first on Bladder & Bowel UK.

What we eat can affect our health. Diet is particularly important in the early years of life because childhood is the time of rapid growth and development and lots of activity.  It is also a time when behaviours and habits are learnt that may continue to have an influence into adulthood.

Constipation and diagnosis

What we eat affects our bowels as well as the rest of our body. Constipation is known to affect about 10% of children and if not treated quickly can last for weeks, months or even longer. Although it is most likely to start when children are toddlers, it is known that it can occur in babies, particularly around the time of weaning and in older children as well.  Constipation is not always easy to diagnose in children as there are different symptoms which are not always recognised. Not all children who are constipated pass hard or infrequent poos, which are the things that most families associate with this problem.

Constipation can cause abdominal pain, soiling (where poo leaks into the child’s clothing), poor appetite, poor behaviour, low mood. It can affect school attendance and how well children do with their education. It impacts on the whole family, particularly if there is soiling.

Constipation and poor diet

The belief that constipation is associated with poor diet, particularly a lack of fibre and of not drinking enough water-based drinks is still common. However, research evidence suggests that this may not be the case for most children. While it remains true that healthcare professionals are often unable to find the underlying cause of constipation for many children who have the condition, some studies suggest that constipation may have a genetic element or other causes rather than low fibre intake.

The National Institute for Health and Care Excellence (NICE) produced guidance on constipation in children in 2010. This advice and the research evidence underpinning it has been reviewed several times since, but remains: ‘Do not use dietary interventions alone as first-line treatment’ for constipation in children. This is because NICE found that there was no evidence to suggest that giving children more fibre to eat would, on its own, improve the constipation.

So, what should the advice be for children with constipation and for their families?  Treating constipation in children according to NICE guidance involves use of laxatives as the initial intervention. Usually macrogols are tried first: Cosmocol, Laxido and Movicol are all macrogols that may be prescribed for children. Once the child’s constipation is improving lifestyle advice should also be given. This involves providing information about food, drinks and regular toilet visits to try and poo, usually at least once a day after meals.

Constipation and fluids

Children with constipation should be encouraged to drink the right amount of water-based drinks each day, for their age, size and activity levels. Water is needed by the body and if insufficient is drunk each day, the body will try to retain water where it can. That includes reabsorbing more from the poo, creating drier, harder poos that may contribute to constipation. However, there is no evidence that increasing fluid intake alone will treat constipation in children.

The correct amount of water for children is about 600mls for children aged 7–12 months, 900mls for 1–3 year olds, 1200mls for 4–8 year olds, 1600mls for girls aged 9– 3 years old, 1800mls for boys aged 9–13 years old, 1800mls for girls aged 14–18 years old and 2600mls for boys aged 14–18 years old. If children are very active, overweight or in hot environments they will need more than this.

It is suggested that children with constipation have the same fibre intake as is recommended for their peers. For children aged 2 to 5 year-old this is about 15g of fibre a day; for 5 to 11 year-olds it is about 20g and for 11 to 16 year-olds it is about 25g. Children should get much of their fibre from fruit and vegetables high-fibre bread, baked beans and wholegrain breakfast cereals. Children should not be given unprocessed bran, as this can cause bloating and wind and reduce the absorption of some nutrients in their food.

Rarely constipation in children may be associated with a food intolerance or allergy. The most common of these include an intolerance to dairy products or to gluten. Gluten is a protein found in wheat, barley and rye. However, children should not have dairy products or gluten-containing foods removed from their diet without the advice of a healthcare professional.

More information on constipation in children

If you are concerned that your child may be constipated or have a problem such as an allergy or intolerance to a particular food, do speak to their healthcare professional (GP, school nurse or health visitor) for advice, as constipation can happen in children who already have healthy eating and drinking habits and adjusting diet and fluids alone is unlikely to make the problem better.

There is more information about constipation and its management for children, and on other bladder and bowel conditions experienced in childhood, on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/children-resources/.

There is a table with more information about how much fibre is in different foods in the leaflet Understanding Childhood Constipation at https://www.bbuk.org.uk/wp-content/uploads/2020/12/Understanding-Childhood-Constipation-1.pdf

Bladder & Bowel UK publish a quarterly e-newsletter, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive the newsletter please send an email to bbuk@disabledliving.co.uk, You can find out more on our newsletters page.

To contact our confidential helpline, fill in our confidential helpline enquiries form.

For more information about bladder conditions in children visit: https://www.bbuk.org.uk/bladder-resources/.

The post The impact of diet on constipation in children appeared first on Bladder & Bowel UK.