Monday 20 October 2014

Help! How do I cure my bed-wetter?

My 10-year-old son still wets the bed at night. It can happen several times a week.

Dr Nina Byrnes

Published 18/08/2014 | 00:00

In most cases bed-wetting can be treated or will resolve itself.
In most cases bed-wetting can be treated or will resolve itself.

My 10-year-old son still wets the bed at night. It can happen several times a week.

This is very embarrassing for him and it means he avoids sleeping over in friends' houses. I'm afraid this is really getting him down. Are there any solutions?

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Dr Nina Byrnes replies: Bed-wetting, or nocturnal enuresis as it is medically known, has been around for a long time. It can be traced as far back as 1500 BC. It is relatively common. Wetting the bed less than two times a week is thought to affect 21pc of those aged four-and-a-half and 8pc of those aged nine-and-a-half. More frequent wetting is thought to affect 8pc of those aged four-and-a-half and 1.5pc of those aged nine-and-a-half. It resolves in most people by the age of 18, but even 2-3pc of those over 18 are thought to suffer from some bed-wetting.

There are two types of nocturnal enuresis. The first is primary nocturnal enuresis. That means that the bed-wetting has been present since birth. Secondary nocturnal enuresis occurs when bed-wetting starts again after a period of being dry for at least six months.

The bladder is essentially a sac that holds urine that passes from the kidneys before it is passed out of the body. If a bladder is functioning normally, nerves in the bladder wall let the brain know when it is full but the brain can also send a message stopping the bladder from emptying until the person decides to empty it. The skill of controlling bladder emptying is learned when we are toilet training. In those with nocturnal enuresis, the message telling the bladder not to empty either isn't sent or isn't heard.

The cause of nocturnal enuresis isn't fully understood but there are a few possible causes. Your genes are important. If you have two parents who were bed-wetters the chance of having this is 77pc. If one parent was a bed-wetter, the risk is 40pc. Hormones may play a role. A hormone called anti-diuretic hormone (ADH) limits the amount of urine the kidneys produce and we normally produce more of this hormone at night. If this is deficient it may increase the chance of bed-wetting. The nerves controlling the bladder may be overactive or the bladder may be sensitive to smaller amounts of urine, therefore emptying more easily. Some people sleep so deeply that they don't awake when the brain sends a signal that the bladder is full.

In children, severe constipation can also put pressure on the bladder making involuntary wetting more likely. Caffeine and alcohol are bladder irritants and may exacerbate the problem in older children and adults. Certain prescription medications also make the condition more likely while infections and rare abnormalities of the urinary system may cause problems.Psychological issues need to be considered in those who start wetting after a period of dryness. Consider whether there has been any major life change such as separation, bereavement or divorce.

Bed-wetting occurs twice as often in boys than girls and is more common in those diagnosed with ADHD. Bed-wetting up to the age of five is almost considered normal and so it is only in those over this age that further investigations and treatment are suggested.

The first thing to do is keep a diary. Keep a record of the amount of fluid taken. The pattern of drinking is relevant. Is it consumed mainly early or late in the day? Are there a lot of fizzy or caffeinated drinks consumed? Record how often the child goes to the toilet, whether the bowels are moving normally and whether there are any symptoms such as stinging passing urine, cloudy or smelly urine, or reduced strength of the stream.

How does the bed-wetting occur? Is it early or late in the night? How many days a week is it happening? Does the child wake up after wetting the bed? A visit to the doctor with the diary will help identify the likely cause.

If your child is only wetting the bed a few days a week and is waking up after he wets then put in place a fluid management plan. Parents often restrict a child's fluids dramatically if they are bed-wetting. However, this is not recommended. Depending on a child's age they need between one and 2.5 litres of water daily. Fluid intake should be reduced in the hour or two before bed and it is really important to make sure they pass urine last thing at night.

Rewards should be given for drinking enough water, passing urine regularly, and helping manage the problem such as helping change the bed sheets. It is really important not to punish or chastise the child.

If a reward system isn't working, an alarm may help. These alarms are sensors that are worn on the body or in a pad placed on the bed that are triggered by moisture. The idea is that they train the child to wake on passing urine. The alarm should be used every night until there have been 14 dry nights. This usually takes three to five months.

The third treatment option for children is synthetic ADH which helps reduce the production of urine at night. A course of three months is usually prescribed. Many parents practice lifting the child in their sleep to go to the toilet - this isn't actually recommended.

If a treatment is working you will notice smaller wet patches, more waking with wetting and reduced wet nights. The important thing is to support your child and remain positive through the process and reassure them that in most cases bed-wetting can be treated or will resolve itself.

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