It’s 4am and a sleepy little voice is heard saying “My bed’s wet again!”, or yet another pile of soaking linen is discovered in the corner of your teenager’s room just as everyone is getting ready to leave the house in the morning. If this scenario is a familiar one, you are certainly not alone. It is likely to be happening in three-quarters of a million households in the UK every night.

The Helpline provided by the national charity ERIC (Education and Resources for Improving Childhood Continence) receives many calls from parents who are too embarrassed to seek advice or feel unsure about who can help them with their child’s bedwetting (also known as nocturnal enuresis). Since ERIC was set up 20 years ago to provide information and support, an increase in research has led to a better understanding of this common condition.  

Why do children wet the bed?

It is not unusual for children under the age of five to still be wet at night, or to have occasional wetting accidents in the day. We do not fully understand why some children take longer than others to master the art of staying dry, but we know it is not linked to poor toilet training or laziness on the child’s part.  For most children the situation will resolve itself with the aid of a few simple measures (see ‘What can parents do?’ below).

It is known that there is a genetic link which suggests that late toilet training and bedwetting can run in families. Other factors, such as constipation and urine infections are known to affect the bladder and should always be checked by your GP or health visitor, especially if daytime wetting continues beyond the age of five.

For the one in seven children who wet the bed beyond the age of seven, a full assessment of the problem will help identify any possible physical factors. This will be the guide for choosing the best treatment for your child and the school nurse or GP should be able to direct you to a specialist continence clinic or service.

Research shows that one percent of children continue to wet the bed as adults, but the possibility of this happening is reduced if the right treatment is given at an early age.

What are the physical factors that cause bedwetting?

There is evidence that bedwetting happens as a result of one or more of the following factors:-

• The child is not reacting to the signal from the bladder to the brain which tells a child to ‘hold on’ or to wake up. An alarm or buzzer which sounds when urination begins, will help a child to wake and to hold on to the sensation of a full bladder.

• The body’s system, controlled by a natural hormone called vasopressin which acts on the kidneys and slows down the production of urine during sleep, is not yet working.  So the child has to cope with larger quantities of urine in the night. There is a medication called Desmopressin that can be prescribed to help this.

• The bladder holds smaller amounts of urine than expected before sending the signal that it is full; this may be due to an overactive bladder. There may also be a need to go to the toilet urgently or more often in the day. There is also a medication that can treat the overactive bladder. Regular drinking and a toilet routine will also help.

• Changes or stresses in a child’s life, such as starting school, may trigger bedwetting in children who have been dry for six months or more. This is called secondary enuresis and requires the same assessment and treatment as if they had never been dry at night (primary enuresis).

What can parents can do?

There are some simple measures that will increase the chance of successful treatment and help the family cope until things improve.

• Try to stay patient and calm so that your child does not become anxious. A positive approach will help to reassure your child that they will succeed.

• Make sure that your child drinks 6-8 cups of water-based fluid spread out evenly across the whole day. Cutting back on drinks does not help.

• Experiment to see if any drinks, such as flavoured drinks, increase the problem and avoid these.

• Ensure your child does not put off going to the toilet in the day and encourage a visit to the toilet last thing before settling down to sleep.

• Leave a soft light on to guide the way to the toilet at night and clear any obstacles from the route.

• Use bedding protection such as bed mats and duvet protectors (available from ERIC). Absorbent pants are also useful for under-fives and for holidays, but these are best dispensed with once your child seems ready for treatment.

• Lifting at night does not help children to become dry. You may choose to do this occasionally, but ensure that you vary the time and try to ensure that your child is fully awake.

• Design a chart with your child to reward the tasks that they can achieve, such as drinking regularly rather than just for being dry.

What treatments can be offered?

Alarms can be the body worn or bed mat type and can be used successfully for children from the age of five. It is important your child is well motivated and for you to be able to help by listening out for the alarm and prompting your child in a calm way when it goes off. It is recommended that the alarm is used with the support of a specialist continence nurse. NHS clinics will often loan alarms, but some parents may choose to purchase their own (available from ERIC).
 
Desmopressin can be prescribed from the age of five. It mimics the natural hormone that reduces the amount of urine produced during sleep. It is available as a tablet or ‘Melt’ and must be given last thing at night. It stays in the body for 8-10 hours and for some children results in a dry night.
 
Oxybutynin is a medication prescribed to reduce the symptoms of bladder overactivity and works by helping the bladder to relax.

What if the treatments don’t seem to work?

Try to remain positive.  If one treatment does not work, the specialist clinic should reassess to find out why and to adapt the treatment accordingly.  A break from treatment can sometimes be necessary when no progress is made; trying again when the child is at a different stage often brings better results.

What can ERIC offer you?

• A confidential Helpline 0845 370 8008 is available Monday to Friday, 10 am – 4pm to provide information and a ‘listening ear’.  Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
• Interactive websites: www.eric.org.uk and www.trusteric.org (young people’s site) for information, message boards and downloadable leaflets.
• Webshop www.ericshop.org.uk and a catalogue of resources including alarms, literature, bedding protection and washable absorbent products.