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.

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Product testing regulations in the UK are among the best in the world, so soreness due because of a reaction to something in the nappy itself is unlikely, whether you chose to use disposables or washables.

There are many reasons for children getting nappy rashes from disposable nappies. These include:

• Strong urine (wee), which may irritate the skin. Increasing water and water-based drinks throughout the day, for babies who have weaned, may help make the urine less irritating. Ask your health visitor for advice.
• Both modern cloth and disposable nappes are good at absorbing urine quickly. However, cloth nappies need careful washing and drying to make sure they are properly clean, and disposables need to be changed before they are completely full to ensure that moisture does not remain against the skin.
• Follow the manufacturer’s instructions when washing and drying cloth nappies and consider whether your choice of detergent may be the reason for a skin rash if one develops.
• Children not being changed quickly enough after they poo. It is not always possible to change a child immediately, but wee and poo together can cause nappy rashes.
• Sometimes the child’s diet may increase the likelihood of poo causing skin redness.
• Some children have dry skin, or eczema. They may also get skin infections in their nappy area.
• Some children are sensitive to some wipes. Water and washable wipes may be an alternative.
• If the nappy is too small or fits poorly, it is more likely to cause rubbing and irritate the skin resulting in red areas. Getting the correct size is important. Washable nappies tend to be more adjustable to your child’s changing size as they grow.  For disposables you should purchase the correct size – the size usually varies according to your child’s weight.
• If the nappy has leaked or is over filled, the moisture remaining next to your child’s skin and may cause irritation.
• A child who wears a nappy is more prone to have a rash than those wearing cotton pants, as the air is less able to reach the skin. Where possible allow your child some nappy-free time during the day, particularly if skin irritation or nappy rash is a problem.
• Starting to work on the skills for potty/toilet training early is a good way of managing or avoiding nappy rash. Consider sitting your little one on a potty after feeds or drinks, when they learn to sit independently, to see if you can catch a wee or poo. Not only will that reduce the time they have moisture next to their skin, but it may help them develop a skill they need for potty training.

There is more information about potty training on the Bladder & Bowel UK website at: https://www.bbuk.org.uk/toilet-training-resources/.

Signs of poorly fitting nappies

• Red marks on the skin beneath the nappy may be due to rubbing or chafing, often inside the thigh.
• Children may fiddle with their nappy if they are tight or uncomfortable.
• Toddlers may walk awkwardly or even resist having a new nappy put on if they are uncomfortable to wear.
• Disposable nappy tapes may stick to the skin if there is not enough stretch.
• The nappy leaks.

Disposable nappies often fit better if, after taking them from the pack, they are folded in half lengthwise and tugged gently, to help the elasticated cuffs to stand up and act as a more effective leakage barrier.  Washable nappies come in a range of sizes, but many will accommodate babies and toddlers across a range of sizes. It is still important to make sure that you use them correctly.

Avoid using talc or barrier creams on your child’s nappy area, as these can block the special one-way pores in the nappy. The pores are designed to let wee through into the nappy quickly and keep it there so your child’s skin stays dry. If your child does need a cream on their nappy area, then use the minimum you can and rub it in well.  Do not wipe any excess on the nappy.

Many children with additional needs or disabilities can toilet train at a similar age to their typically developing peers. There is more information on toilet training children with disabilities available on the Bladder & Bowel UK website (www.bbuk.org.uk) at https://www.bbuk.org.uk/children-young-people/children-resources/

If you have any concerns about your child’s skin, nappy rash or other health issue then do consult their health care professional.

Bladder & Bowel UK have a confidential helpline for anyone of any age affected by a bladder and/or bowel condition, including difficulties with potty training. To contact our helpline, complete an online form at: https://www.bbuk.org.uk/helpline-enquiries/

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Toilet training is a challenge for many families and even more so if a child has disabilities. Once daytime toileting has been mastered not all children naturally become dry at night. It is not possible to teach a child to be dry at night in the same way that we teach them during the day.

Bedwetting or ‘enuresis’ (the medical term for wetting during sleep) is one of the most common medical conditions in children. Because a child has a disability does not mean they cannot have enuresis. Most children who have delayed toilet training will be dry at night about six months after they have learnt to be dry in the day. If your child is over five years old and is dry or mostly dry in the day, but still wet at night then, treatment is available.

Most children sleep all night without needing to wake up to wee. Bedwetting is caused by a child not waking up when the bladder signals that it is full. However, children who wet the bed also have a problem with one of the following:

• The bladder is not big enough to hold all the wee their kidneys make while they are asleep
• The bladder gets ‘twitchy’ and empties before it is full
• The child is not making enough of a special chemical messenger called vasopressin. Vasopressin tells the kidneys to make less wee at night.  If there is not enough vasopressin, the kidneys make more wee at night than the bladder can hold and if the child does not wake up when the bladder is full, they will get a wet bed.

Things you can try to help stop the bedwetting

Encourage your child to drink plenty of water-based drinks during the day, about 1.5 litres is right for most school aged children. Try to avoid giving your child tea, coffee, hot chocolate, cola and energy drinks as these contain caffeine, which can make wetting worse. Fizzy drinks can irritate the bladder so should also be avoided.

Try to make sure your child is not constipated. If the bowel is full of poo, this can upset the bladder and cause bedwetting or make it worse. If you are worried that your child might be constipated, speak to their doctor or nurse.

Try not to give your child a drink or any food in the last hour before bed. The kidneys make more wee after a drink or food, particularly food that has a lot of salt or protein in it, so having these before bed can increase the likelihood of wetting.

Make sure your child has a wee just before they settle for sleep. Try to have the same bedtime routines every night, avoid light in the bedroom and try not to let them use electronic devices just before bed.

What if these things don’t work?

If you have tried to do the things suggested above, or if your child cannot manage them and the bedwetting is still happening, then you should speak to their GP, practice nurse or school nurse about assessment and treatment for bedwetting. Some areas have special clinics for children that wet the bed or have other continence problems. There are several treatments available and these should be discussed with you.

Things to remember

• Bedwetting is not your child’s fault
• Bedwetting does not happen because of anything you or your child has done or are doing
• Children with disabilities can be offered assessment and treatment for bedwetting
• There is help and support available

Where to find more information:

• Your child’s doctor or nurse
• The following websites:

https://www.bbuk.org.uk

http://stopbedwetting.org/

If you want more information on toilet training a child with a disability, Bladder & Bowel UK also have a confidential helpline at bbuk@disabledliving.co.uk or at Tel: 0161 214 4591

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