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.

The post What is World Bedwetting Day and why is it important? 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, 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.

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.

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.

Bedwetting (enuresis) is now a recognised as a medical condition with a number of different causes. These include not waking up to bladder signals, too much night time wee being produced, and problems affecting how much the bladder can hold. Other factors include constipation, what, when and how much children drink, whether the child snores and diet.

Dryness at night

As a result of the potential different factors the success rates of single line treatments, such as desmopressin or alarm, have on average a success rate of around 60%, telling us that potentially 40% of children will require combined or other initial treatments, aimed at addressing any other contributory factors, to achieve dryness.

Staying dry at night is a fine balance between the volume of night-time urine produced and the ability of the bladder to store that urine until morning. For treatments to be effective all contributary causal factors will need to be resolved. For example, even if a treatment, such as desmopressin, is effective in reducing any over production of wee at night to a ‘normal’ night-time volume, unless the bladder has enough capacity the child will still wet.

This highlights the important of children having a full holistic assessment prior to commencing any treatment to ensure all underlying factors have been identified and can therefore be addressed. This enables a plan of action to be put in place, based on the outcome of the assessment, and can include such things as encouraging more water based drinks, and ensuring the child goes for a wee just before sleep, for example.

Drinks

Recording when, what and how much the child drinks is helpful in identifying if the child is not drinking enough or drinking too much of the wrong type of drink at the wrong time, in the evening for example. The fluid intake needs to be optimized, with water-based drinks encouraged and restriction of carbonated and caffeinated drinks.

Constipation

Also, how often and how much the child wees will help identify if there are any underlying bladder problems and recording bowel movements will help identify if constipation is present. Constipation is often not recognised either by the child or the parent. However, it should always be excluded as, importantly, often bedwetting improves, or even resolves once any underlying constipation is treated. Any bladder or bowel problems should always therefore be addressed first.

Sleep disorders

There is now a clear recognition between sleep disorders and bedwetting. As a result, children who are reported to snore or have episodes of disrupted breathing during sleep should be referred for further assessment.

Role of diet

More recently the role of diet has been considered as a contributary factor for bedwetting, with some discussions regarding the role of dairy-based products on how much wee is produced. Salty foods are also said to cause an increase in wee production. Although the evidence is not clear it might be beneficial to suggest that these foods are restricted in the evening.

Lit screens

Using lit screens for more than two hours at a time has been shown to affect children’s sleep. Although there is currently no agreement regarding the direct impact this has on a child’s bedwetting it would seem sensible to suggest that screens are not used in the hours before bedtime.

Addressing all the potential contributary factors first will give the child the best chance of achieving dry nights.

More advice and information on bedwetting

The Bladder & Bowel UK website has a range of downloadable resources for both families and professionals as well as links to helpful videos.

For further advice and information do not hesitate to contact Bladder & Bowel UK via the confidential helpline on 0161 214 4591 or via email bbuk@disabledliving.co.uk.

The website www.stopbedwetting.org also has a range of resources to help raise awareness of bedwetting and empower families.

Further information regarding World Bedwetting Day can be found by visiting: https://www.worldbedwettingday.com/

The post Improving treatment outcomes for bedwetting appeared first on Bladder & Bowel UK.

Foster carers have a challenging role providing support, love and encouragement to children who are not able to live with their own families. For those managing bedwetting as a foster carer this is often difficult, and can be more so if the child they are supporting has a bladder or bowel problem.

Bedwetting, also known as enuresis, is one of the most common medical problems that children experience. It is often assumed to be happening because of an emotional or psychological problem. This may be the case if bedwetting starts suddenly after a traumatic event in a child who has previously been dry.

Although there is an acknowledged link between trauma or stress and bedwetting, the bedwetting itself may be causing or contributing to any emotional or psychological problems. Therefore, it is important for any child, over five years of age, who is wetting the bed at night to have a full assessment of their bladder and bowel health. It should not be assumed that the bedwetting will get better on its own once the child’s life is more settled.  Although this does occasionally happen, it is not always the case. Furthermore, the bedwetting will not get better if there is another underlying physical cause for it.

Bedwetting happens for a combination of reasons:

• The kidneys are making too much urine during sleep. Usually the kidneys make less urine at night than they do during the day. If they are not able to reduce urine production at night, the bladder is likely to fill before morning and need to be emptied.
• The bladder is not working as well as it should and is not able to hold urine as well as it should. This may be because the bladder is not as large as it should be, or because it is getting ‘twitchy’ as it fills.
• All children who wet the bed do so because their brains are not able to wake them up when the bladder sends signals that it needs to empty. This is the main reason why children pass urine while they are asleep. If they were able to wake up to the bladder signals, they would go to the toilet.

Children do not wet the bed because they are lazy, naughty, or defiant. They do not wet because of anything they, you, or their families have done wrong. They do so because they have an underlying medical problem. It is very common for children to have a mixture of wet and dry nights, although some children are wet every night. Having some dry nights does not mean that they are able to be dry every night. Children may be more likely to be wet at night if:

Children may be more likely to be wet if:

• They are constipated – if the bowel is full it will put pressure on the bladder and increase the chances of wetting in the day and at night. That is why any child with a bladder problem should also have an assessment of their bowel. Constipation should be treated before day or night time wetting, as the wetting sometimes gets better once the constipation has improved.
• They have a problem with their bladder in the day. Children who get damp pants in the day, need the toilet frequently, or who have to rush to get to the toilet (look as if they have left it to the last minute) are more likely to have wet nights. These children may have a bladder problem called overactive bladder. This can be treated.
• They do not drink enough during the day – concentrated urine can irritate the bladder and make wetting during the day and night more common. Not drinking enough may also cause constipation.
• They drink the wrong things. Drinks containing caffeine (tea, coffee, hot chocolate, cola and some energy drinks) and fizzy drinks may irritate the bladder and make wetting more likely.
• They drink large quantities before bed. This will make the bladder more likely to fill and need to empty during the night. Children should have 6 – 8 drinks evenly spaced through the day, with the last drink about an hour before bed.
• They eat just before bed. There is evidence that dairy products, including milky drinks, salty foods and foods high in protein can all increase urine production. Therefore, these should all be avoided in the hour before bed.
• They are very tired – they may be even less able to wake to bladder signals than usual.
• They go to bed very early – if they sleep for longer there is a higher chance their bladder will fill before morning.
• They forget to wee before going to sleep. They should be reminded to go for a wee just before they settle to sleep.

What can a foster carer encountering bedwetting do?

For those managing bedwetting as a foster carer it is important that you notice and support any efforts they make to improve things. These might include drinking well during the day, using the toilet just before they go to sleep and helping to change their own bed.  You may want to offer them small rewards for trying to make positive changes in the day. However, you should never offer them rewards for dry nights – they are not able to control their bodies during sleep and are likely to sleep differently or try and stay awake to earn the reward.  The wetting may get worse the next night.

If the wetting continues then you should ask their healthcare professional (GP, school nurse or health visitor) for an assessment and support. The website Stop Bedwetting has lots of information about how to make small adjustments at home that might help and has suggestions for how to approach the subject with a child’s healthcare professional.

More information and advice

Bladder & Bowel UK also have information about bedwetting on their website here.

Bladder & Bowel UK offers a confidential helpline to anyone who is affected by a bladder and/or bowel condition, including foster carers who are supporting children and young people with bedwetting. Contact us at bbuk@disabledliving.co.uk or telephone 0161 214 4591.

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Children cannot learn to be dry at night in the same way that they learn to use the potty or toilet during the day. Night time dryness occurs as a result of a developmental process. The kidneys need to be able to reduce the amount of urine produced during the night. This is controlled by a chemical messenger (vasopressin) that is made in the brain. If there is not enough vasopressin the kidneys will make too much urine during sleep. The bladder needs to be big enough and working well enough to hold all the urine that is made during sleep. If there is a problem with either the production of vasopressin or with the bladder or with both, then to remain dry overnight, the brain has to be able to wake the child up when their bladder needs to empty. If the child has a problem that means their brain is not able to wake them up to the bladder signals, often called ‘lack of arousability’, their bed will get wet.

Children who have never been dry at night are said to have primary enuresis

Those who have been dry every night for at least six months and then start to get wet beds have secondary enuresis. Children do not suddenly start to wet the bed for no reason. They do not wet the bed to be naughty, lazy or defiant. If a child has secondary enuresis it is important that they have an assessment of their bladder and bowel health and are offered appropriate support based on the outcome of the assessment.

Bedwetting can start suddenly for a variety of reasons. It may be as a result of trauma, stress or anxiety. These may include experiences such as a car accident, parental divorce, bereavement, moving house or being bullied at school. Secondary bedwetting is a common problem in children who are looked after. This may be because of the stress that resulted in them going into care, or it may happen after family contact. Reduction of the stress may not automatically resolve the bedwetting, although it may help.

Although sometimes healthcare professionals may assume that secondary enuresis is a response to an emotional or psychological problem, this is not always the case. It may be an indication of an underlying medical problem. Constipation is a very common condition in children but is not always easy to diagnose. A common, but less well-known symptom of constipation is problems with wetting, either in the day or at night or both. This may start suddenly and happens because the full bowel is pressing on the bladder.

Another common cause of secondary bedwetting is a urinary tract infection

In children a sudden start to wetting after a long time being dry may be the only sign of an infection. Other causes of occasional wet nights, particularly in younger children may be a change in habits. Having a large drink before bed, including where a child is learning to swim, and drinks some of the pool water may cause bedwetting to start. Fizzy or caffeinated drinks that can irritate the bladder may result in a wet bed. Forgetting to go to the toilet before going to sleep may result in the bladder becoming overfull and having to empty before the morning. Having a snack before bed that includes salty or high protein foods may cause bedwetting to start again, because salt and protein cause an increase in urine production.

Rarely bedwetting may be an indication of a more serious underlying health condition. Children who are developing diabetes become very thirsty, and struggle to be able to concentrate their urine. Therefore, they are likely to need the toilet more often during the day and may be tired and lose weight as well. However, bedwetting might be the first sign of diabetes, although this is a rare condition in children.

Whatever the suspected cause, it is important that any child who suddenly starts to wet the bed again at night after a period of being dry should have an assessment and be offered appropriate treatment based on the outcome of the assessment. The 26^th May 2020 is World Bedwetting Day with the theme this year being ‘Time to Take Action’. Therefore, if you have any concerns about secondary bedwetting do take action and contact your child’s school nurse or GP and ask for help.

Learn more about secondary bedwetting

There is more information about bedwetting available online at www.stopbedwetting.org.uk and on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/children-resources/

Bladder & Bowel UK have a confidential helpline to offer advice and support to anyone affected by bladder and bowel health issues. Contact us on 0161 214 4591 or email bbuk@disabledliving.co.uk

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Bedwetting is caused by deep sleep – myth

Most children do not need to wake to pass urine in the night. If a child needs to wee at night, it is either:

• because their body cannot reduce the amount of urine (wee) that they produce overnight (we usually make a lot less wee when we are asleep than we do when we are awake),
• or because their bladder is not able to hold enough urine at night, because it is not working as well as it should,
• or both.

Children wet the bed because they have a problem that means they cannot wake up to signals from the bladder saying that it needs to empty. This is sometimes called ‘lack of arousability’. The bladder still sends those signals to the brain and the signals still disturb the sleep of children who wet the bed, even though the children do not wake up properly and therefore are not able to get up and go to the toilet. However, because the signals are still being sent by the bladder to the brain, children with bedwetting are likely to have poorer sleep quality than children who are dry.

Bedwetting is caused by laziness or naughtiness – myth

Disturbed sleep (from the full bladder signals that are not enough to wake them) makes children feel more tired in the day. The tiredness may affect their behaviour during the day. Children may also become frustrated if they are expected to try and solve a problem that is outside their control. The frustration may make them appear naughty and sometimes makes them try to hide the problems. Some children might hide wet pyjamas or sheets, particularly if they think they are going to get into trouble for the wetting or if they have been teased or bullied about it.

Children do not usually wet their beds when they are awake. If they do this, then it is because they have a different problem that is stopping them getting up and going to the toilet. For some children this may be that they are frightened of going to the bathroom on their own at night. They might find it easier to use a disposable pant or nappy if they wear one, particularly if it is cold when they get up or they have been told off for disturbing other members of their family who are still asleep.

Children should never be punished for wetting the bed. Bedwetting is not caused by something you or they are doing wrong and is not done because the child is being lazy, naughty, or defiant. If you are struggling to cope ask their GP, school nurse or health visitor for help or contact the Bladder & Bowel UK confidential helpline.

Bedwetting is a psychological or emotional problem – possibly

Some children start bedwetting after a traumatic life event. There is some evidence that bedwetting can be linked to psychological and emotional problems. However, this is not the case for most children. It should therefore not be assumed that children are wetting the bed for these reasons.

Bedwetting itself can cause psychological and emotional problems. Therefore, it should never be assumed that a psychological or emotional problem is the cause and that consequently the bedwetting will just get better if the stress goes away. All children with bedwetting should be offered an assessment of their bladder and bowel health to try and work out the cause. They should then be offered treatment to fit their needs and that of their family.

Bedwetting is a developmental problem: it will get better on its own in time – partially true

Bedwetting happens more frequently to younger children. It is thought that a delay in maturity of the systems involved could be the cause in some children. It is also known that some children will just get better with no support. However, children who are wet most nights are the ones who are least likely to get better on their own.

If the bedwetting is upsetting for the child or their family, they should be offered assessment and appropriate support. Bedwetting is considered a medical problem from age 5 years, but there are some simple changes that can be made which may also help younger children.

A simple treatment for bedwetting is waking children for the toilet – myth

There are still many people, including health care professionals who think that waking children to go to the toilet is the right approach to stop bedwetting. While this does work for some, it does not address the underlying problems. Furthermore, many children do not remember being taken to the toilet at night, even if they appear to be awake.

‘Lifting’ or waking a child to take them to the toilet can be useful as a short-term measure to keep a bed dry, for example when on holiday or sleeping at someone else’s house. However, in the long term it does not address the underlying causes and there are thoughts that it may make the problem last longer by encouraging the child to wee when they are not fully awake.

Bedwetting is a common problem in children and is caused by an underlying medical condition – FACT

Today we know that bedwetting is one of the most common medical problems experienced by children. Many children respond well to basic lifestyle changes or simple initial treatments. However, some children and particularly teenagers and young adults need more specialist support to overcome this distressing medical condition.

If you or someone you know is affected by bedwetting, then World Bedwetting Day on Tuesday 26^th May 2020 is ‘Time to Take Action’. You can talk to your child’s GP, school nurse or health visitor. They may be able to refer your child to a local bedwetting or enuresis service. There is information on how to have the conversation with your healthcare professional as well as lifestyle changes you can try at www.stopbedwetting.org. There is also more information on bedwetting on the Bladder & Bowel UK website at www.bbuk.org.uk.

Contact the Bladder & Bowel UK confidential helpline for more advice and information at email bbuk@disabledliving.co.uk or on telephone number 0161 214 4591.

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Yesterday someone, when warned by a relative not to ask what my job is, said “…I don’t mind… I had children… and I changed nappies.” Others say they don’t understand how I can work with wee and poo. But I don’t – I work with children and families. Few people who are not affected by problems with daytime wetting, night time wetting, constipation or soiling (when poo leaks into underwear) really understand how much difference my job can make. However, I try to help children and young people who are struggling with embarrassing problems that affect their lives and their families’ lives.

Bedwetting is the most common childhood continence problem

It affects up to 15.5 % of 7 ½ year olds. 3.3% of 7 ½ year olds have the problem more than two nights a week. Many children do not get better as they get older. 2% of teenagers are affected by bedwetting, as are some adults. Most teenagers who wet the bed are doing so at least three nights a week. Many children and young people affected have other continence problems. These include constipation, day time wetting, urgency (having to get to the toilet quickly) or frequency (having to go to the toilet more often than usual).

What lots of people do not know is that bedwetting can and should be treated in all children over the age of five years. For children younger than this, simple changes might make a difference. Therefore all children with bedwetting should be helped to understand that:

Drinking well is really important to help the bladder work well

• Primary aged children should be drinking about 1.5 litres of water based drinks a day
• Secondary school children should be drinking more than this and secondary school aged boys should be having up to 2.5 litres of water based drinks per day
• Children should avoid fizzy drinks as these can make bedwetting worse, by irritating the bladder
• Children should avoid drinks with caffeine in them (tea, coffee, hot chocolate, cola and many energy drinks). Caffeine can irritate the bladder and encourages the kidneys to make more urine (wee)

Eating plenty of fruit and vegetables helps prevent constipation. Constipation may cause bedwetting, or make it worse.

• Children who are constipated should have this treated as part of the treatment for bedwetting

They need to try and wee just before going to sleep. This makes sure they start the night with an empty bladder and gives them the best chance of a dry night.

It is also important that healthcare professionals understand that bedwetting may be caused by several different things

This includes the kidneys making too much wee during the night, the bladder not being able to store the wee for the full night and children not being able to wake up when their bladder is full. Healthcare professionals need to understand how to assess and treat children with bedwetting and how to help families chose treatments that will help.

Most healthcare professionals are not taught about children’s continence problems, including bedwetting when they are training. Therefore, a large part of my job involves training them about how to care for children and families. I also have been involved in teaching families about bedwetting and its treatment. It is important that families know there is help available for all children from the age of five years old and where they can find reliable and good information to help them.

The International Children’s Continence Society and European Society for Paediatric Urology recognised that many people underestimate the impact of bedwetting and that it affects children and families across the world. Therefore in 2015 they started World Bedwetting Day to help raise awareness of the problem. This year World Bedwetting Day is on Tuesday 28th May. There is more information about World Bedwetting Day at worldbedwettingday.com

Bladder & Bowel UK have lots of information leaflets for children and families

These resources are available on their website at bbuk.org.uk/children-young-people/children-resources/. These are all free to download and print. They also offer a confidential telephone helpline and email address to anyone affected by a bladder or bowel problem. This includes bedwetting. This provides confidential advice from qualified nurses who have specialised in continence problems. There is also an excellent website with lots of information about bedwetting and resources to help families speak to their healthcare professional about the problem at stopbedwetting.org.

Bladder & Bowel UK continues to offer training to healthcare professionals and to others about all aspects of continence including bedwetting.

For more information or support go to bbuk.org.uk or email bladderandboweluk@disabledliving.co.uk or telephone 0161 214 4591.

Davina Richardson

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