Bed Wetting

Night bedwetting or nocturnal enuresis occurs in 20% of five year olds, 3% of 10 year olds and 1% of adults. Boys outnumber girls more than 2 to 1. It can cause significant psychological distress to the sufferer and result in depression and poor self esteem. Between the ages of 5 – 7 35% of bedwetters will spontaneously stop each year. Between 7 – 10 years about 23% stop each year and after 10 years only 5% stop. There are many myths about bedwetting which contribute to the stigma associated with it. This page should help the parent and sufferer with some explanation and treatment options. If you have a child under the age of 6 years then the best advice is to leave him or her alone.

What causes it ?

There are three basic reasons for enuresis:

Firstly it is due to a limited response by the brain to a full bladder. When the bladder is full it does not notify the brain to wake and empty. It eventually empties itself without the sufferer realising. This is called the arousal deficit

The second reason relates to the amount of urine that is made. Normally as children grow, a hormone called vasopressin produced by the brain helps the kidney to slow down at night which helps with dry nights. About 60% of people with bedwetting have a delay in the production of this hormone. If there is bedwetting soon after going to sleep this is a clue that this factor is primarily involved in the bedwetting process.

The final factor is bladder irritability. There are a number of people who’s bladder ’empties’ with very little notice. These people will often have daytime problems aswell.

Does it run in families ?

Bedwetting has been found to be carried in families. One or both parents may have been suffered from bedwetting themselves. Often the child will bed wet until about the age the parent ceased bedwetting.

Can night bedwetting be anything else ?

Nighttime bedwetting occasionally is due to a problem with the kidneys or the bladder. If a child who has previously had no problems suddenly starts suffering from enuresis this needs to be looked at closely. In addition the child who has both day time and night time problems also needs to be assessed for bladder or kidney problems

What is the treatment ?

Thankfully most of the home remedy treatments metered out by well meaning parents/grandparents/relatives are slowly being eliminated. It is important to note that 15 – 35% of children each year will naturally improve – so any treatments have to have success way above this for there to be any evidence that they work. Despite the success of alarms and the nasal spray there is no 100% surefire method. If the following does not help then support and reassurance are going to be needed. There are plenty of adults around who suffer from this condition.

Alarms

These will result in improvement in 60% of children and they work purely on a psychological behaviourial term called conditioning. When the child empties the bladder the alarm will sound and wake the child up. Slowly – over a period of time – the child will wake just before the bladder empties in anticipation of the alarm. Therefore s/he will get out of bed and use the toilet. The alarm works on the first theory above to improve the arousal level to a full bladder. There are two types of alarms – the pad and bell alarm where a mat triggers an alarm when in contact with urine and a small personal alarm to clip onto the underpants. They both are efficient and it is advisable to use the personal alarm for the older children. This treatment is difficult for the first two weeks and parents need to get up when the alarm triggers to ensure their child wakes. They then need to support their child through the process of turning off the alarm, emptying the bladder and changing the sheets and drying the mat. Good alarms are available at www.enuresis.com.au

Desmopressin

This is the medication that mimics the hormone vasopressin. It is given in a wafer form 20 minutes prior to sleep. This will l result in increased urine concentration as the kidneys retain more water and hence slow down the filling of the bladder. As mentioned above about 60% of children will have a delay in the body’s own development of this hormone so this treatment is effective in 60%. It will not prevent the natural process to eventually occur and is safe for long term use if used in accordance with instructions.