Nocturnal Enuresis or bedwetting is a very common condition of childhood. Bedwetting, once the child has started school, can cause considerable anxiety and stress, this in turn, may affect the child’s self-esteem and mental health. It can affect peer relationships, educational opportunities and can impact on family dynamics. So seeking treatment, sooner than later is recommended.
Bedwetting affects 15% to 20% of 5 year old school age children.
The spontaneous remission rate is 14% per year, with the chance of bedwetting continuing through to adulthood, is 1-4%.
Bedwetting has a strong genetic link, it is more common in males, although females are more likely to “pass on” enuresis to their children.
It is estimated only 1/3 of children, with bedwetting seek medical advice.
WHAT CAUSES BEDWETTING
Bedwetting is the involuntary passing of urine at night, in the absence of physical disease beyond the age of 5 years.
Bedwetting symptoms are caused by a combination of 3 factors:
Night-time urine production.
Defective sleep and arousal patterns.
Reduced bladder capacity.
Bed-wetting occurs when the amount of urine produced overnight exceeds the child’s bladder capacity, resulting in the sleeping child wetting the bed. It is believed many children, with bedwetting have an arousal response to a full bladder during sleep, but are unable to fully wake.
HOW CAN WE TREAT BEDWETTING
Treatment for bedwetting can start from age 6. It is not recommended starting any earlier due to immaturity of the child. A positive attitude and compliance from both child and parent, is fundamental to success.
Treatment for bedwetting can include a combination of: Urotherapy, Alarm training and Medication.
Parental involvement is crucial during alarm training. Creating a positive environment and involving the child in decision-making and taking ownership of their problem, is beneficial.
Urotherapy encapsulates a wide range of interventions and advice, which can in some cases resolve bedwetting, so introducing these interventions into your child’s daily routine from an early age, can be beneficial.
Ensure your child has an adequate daily fluid intake. [Approximately 5 drinks per day].
Avoid drinks and foods containing caffeine, [i.e. coke, cola and chocolate]. Caffeine is a diuretic which causes the kidney’s to produce more urine and it can irritate the bladder.
Avoid consuming fluids late in the evening or close to bed. Giving your child, their last drink at least 1-11/2hours before bed. Always ensure your child empty’s their bladder before bed.
Identify and treat constipation, as this can affect your child’s bladder function.
Ensure appropriate toilet posture [i.e.: adequate foot support when sitting on the toilet]. This will help your child with complete evacuation of both their bladder and bowel. Providing a plastic stool and keeping it by the toilet, for easy use.
Ensure regular toileting throughout the day, approximately every 2 hours and encouraging your child not to postpone toileting.
ENURESIS ALARM TRAINING
Enuresis alarm training is the first line treatment for bedwetting.
The aim of alarm therapy is to train the child to withhold urination while asleep or to wake to void with a full bladder signal.
The types of alarms available include:
Pad and Bell [bed] alarm this consists of a mat placed on the child’s bed, which is connected to an alarm box and is activated when it comes into contact with urine.
Body worn [personal] alarm, consists of a sensor, which is either secured in a panty liner or clipped to the child’s underpants. The alarm is activated when it comes in contact with urine.
Both types of alarms are equally effective. The choice is based on availability and acceptance of the chosen alarm. Once alarm training has commenced it should be used continuously until the child has obtained 14 consecutive dry nights. Ensure the child is sleeping close to their parent’s room. The child must wake quickly and effectively to the alarm for successful treatment. It is useful to record your child’s daily progress, stating whether they have had a dry or wet night.
TYPES OF MEDICATION
Medication for treating Nocturnal Enuresis includes Desmopressin and Tricyclics.
Desmopressin is a synthetic hormone, which has an anti-diuretic effect, acting on the kidneys, reducing overnight urine production. Desmopressin is available as a tablet, melt or nasal spray and is effective in about 70% of children.
Desmopressin is useful for short-term effects such as sleepovers, school camps or when alarm training is not practical.
Imipramine and other Tricyclic antidepressants, where originally used to treat bedwetting. Due to their side effects, they are no longer recommended.
Alternative treatment such as Hypnotherapy, Accupuncture and Chiropractic Therapy have previously been tried, but the evidence based research to support their use, is limited.
WHEN TO SEEK HELP
If your child does not respond to alarm training, it is recommended you seek further specialist, medical advice.
The International Children’s Continence Society [ICCS]
The Continence Foundation of Australia
Australian Continence Exchange
Caroline Walsh RN
Nurse Continence Advisor
Children’s Hospital Westmead