Why do some children wet the bed?

The National Continence Helpline, helps hundreds and hundreds of panicked parents who phone in asking for help about their child’s bedwetting and occasional daytime “accidents”. 

WHY DO SOME CHILDREN WET THE BED?

• Some parents describe their children as such deep sleepers, they don’t wake up to the sensation of a full bladder.
• Some children have overactive bladders. If this is the case, they will usually wet the bed more than once  a night, and may have to rush to the toilet at times during the day.
• Some children don’t make enough antidiuretic hormone overnight (which concentrates the urine), so they produce a lot of urine while they sleep.

 SOME BASIC MEASURES TO HELP BEDWETTING 

If your child still wets the bed occasionally at age five, there are a few simple steps you can take to help – particularly with health professionals agreeing that it’s much easier to treat bedwetting earlier rather than later. Children’s continence nurse and National Continence Helpline advisor Claire Fyfield offers parents a few basic tips: 

Make sure your child drinks throughout the day

Give your child a warm drink with breakfast, and milk on their cereal. Have them drink plenty during the day so they don’t want to drink at bedtime, and always have them go to the toilet before bed,” Ms Fyfield said. Some of the cases Ms Fyfield have treated  have left her dumbfounded. “One child I saw had been having milo, tea and coffee before bed – just like mum and dad!” 

Prevent or treat constipation

Many parents were unaware that constipation is a major contributor to children’s bedwetting accidents, according to Ms Fyfield. “A full, compacted bowel presses against the bladder, which in turn puts pressure on the bladder, risking leakage.” But on top of this, straining on the toilet when constipated can weaken the pelvic floor muscles and bladder supports, making urine leakage more likely, she said. With up to 30 per cent of children constipated at any given time (Catto-Smith, 2005), continence health professionals like Ms Fyfield will always check for constipation when a child presents with  a bedwetting problem. “Avoid constipation by providing adequate fluids and a balanced, fibre-rich diet containing plenty of fruit and vegetables. If it’s still a problem, see your doctor for treatment. Avoiding constipation will often improve or end day and night-time wetting.” 

WHEN TO SEEK PROFESSIONAL HELP? 

If the child is still wetting the bed regularly at the age of six or seven, or if they suddenly start wetting the bed after having been dry, it’s time to see a children’s continence professional, Ms Fyfield said. “The family will be asked to chart the child’s food and liquid intake and their bowel and bladder habits. We’ll check for conditions like urinary tract infections, and look at stressful or disruptive situations, such as access weekends, that can affect the child. From this we make a care plan for management.” 

SOME PRESCRIBED BEDWETTING TREATMENTS 

Bedwetting alarms

If everything else is fine – their drinking patterns are good, their bowels are all normal – then parents may try a bedwetting alarm, which has about an 85 per cent success rate,” Ms Fyfield said. She stressed, however, that it was imperative parents consult a continence health professional beforehand, who can determine if a bedwetting alarm is the best form of treatment. 

Medications

Desmopressin acetate, a prescription drug that substitutes a naturally occurring diuretic hormone, can sometimes be prescribed for older children. “It reduces the amount of urine produced overnight by the kidneys. Your prescribing doctor will talk to you about the correct use of this drug, which can also be useful on occasions for older children or adolescents wanting to go on a sleepover or attend camps,” Ms Fyfleld said.  

DAYTIME “ACCIDENTS” 

Daytime accidents are a significant issue, with one in five primary school-age children wetting themselves during the day (Sureshkumar et. al 2000) and one in 25-40 experiencing faecal incontinence (Royal Melbourne Children’s Hospital). Ms Fyfield said that one of the major reasons children wet or soil themselves during the day was because they “held on” to their bladders or bowels for longer than they should. “It may be because the school toilets are smelly, wet or unwelcoming, or because the child forgets to go during play time, and then isn’t allowed during class time,” she said. 

WHY SHOULDN’T WE ‘HOLD ON’ TO OUR BLADDERS? 

A full bladder puts a lot more weight and pressure on the urinary sphincter (the ring of muscle we relax to urinate), making accidents more likely, Ms Fyfield said. “In addition, if the bladder overfills often enough, the bladder – essentially a balloon-shaped muscle – can lose its elasticity and ability to contract effectively and expel the urine.” 

WHY SHOULDN’T WE ‘HOLD ON’ TO OUR BOWEL MOTIONS? 

While most people understand that holding onto their bowel motions causes constipation, many are unaware that constipation could risk faecal incontinence (S R Ali 2011) as well as urinary incontinence, Ms Fyfied said. “Chronic constipation can cause urinary leakage because of the full bowel taking up space in the abdomen and pressing on the bladder. But it can also lead to faecal leakage – often mistaken for diarrhoea, but, in fact, the opposite – constipation with overflow.” This, she said, happens when the semi-liquid faeces higher up in the colon forces its way past the solid blockage without the person being aware. 

HOW CAN SCHOOLS HELP? 

Good habits start early, and to help children get on the right track, the Continence Foundation of Australia has developed a child-friendly Toilet Tactics kit for schools. Toilet Tactics teaches children how to adopt lifelong healthy bowel and bladder habits, and illuminates teachers and parents about the importance of encouraging and reinforcing good practices early. Children learn about diet, exercise, and how their bladder and bowel work and  the importance of responding to the body’s signals. Just as importantly, Toilet Tactics teaches teachers how to recognise the signs a child may be experiencing bladder or bowel control issues, and gives them strategies to handle these situations sensitively and effectively. So far more than 2000 Australian schools have registered for Toilet Tactics. Find out if your child’s school is registered by asking your child’s teacher or your school welfare officer. 

WHERE CAN PARENTS LEARN MORE? 

Contact the National Continence Helpline (1800 33 00 66), where continence health advisors can offer advice, information, resources and the contact details of the nearest children’s continence service. Go to continence.org.au for more information. 

This article is provided by the Continence Foundation of Australia is the peak national organisation working to improve the quality of life of all Australians affected by incontinence.