Nocturnal Enuresis – Bedwetting in Children

Bedwetting, a common and often inherited condition, is present in around 1 in 10 children at 7 years and in 1 in 100 adults. Most children with bedwetting have had this problem since becoming dry during the day. Some children may also have daytime symptoms of urinary urgency, frequency or wetting.
Occasionally children will develop the condition after 5 years in which case it may be possible to find an event that triggered it off.

What causes it?

Bedwetting is always caused by a combination of factors. Not waking up is a major problem but there is always something else including:

  1. A bladder that is to small to hold normal night time urine production
  2. A bladder that is overactive (out of control) at night
  3. Greater than normal production of urine overnight
  4. Occasionally stressful situations

What tests might my child need?

If a child has any daytime symptoms a urine check to exclude infection is sensible. Then measurements of overnight urine volumes (by weighing pull ups/nappies in the morning), bladder capacity (by measuring the maximum volume of urine the child can pass in one go), frequency of passing urine and intake of fluids in the day can help to find the cause.

Normal Values:
Frequency of passing urine is around 5-7 times a day. Intake of clear fluid at 7 years should be around 1.2 litres a day rising to 2 litres by the teens.
Fluids should be evenly spread through the day, not mostly after coming home from school! Bladder capacity for age is calculated by the formula “age+1×30” (up to the age of 11), so a child age 7 should have a bladder capacity of around 240mls.

At age 7 overnight urine volume produced is around 200mls – well under normal capacity for age.

Can it be treated?

Yes! In fact it is important to do so as the success rate with treatment is much higher than just waiting and hoping a child will grow out of it. Children can suffer socially as they will often avoid sleepovers and residential trips.
Treatment strategies range from simple measures to various medications and alarms.

5-7 years

Simple measures include:

  1. Take out of pull ups (if worn) for short periods to see if still needed.
  2. Do not “lift” at night as this may encourage a child to pass urine while asleep.
  3. Check your child is drinking enough clear fluids during the day.
  4. Avoid fizzy and caffeine containing drinks and reduce drinks 2 hours before bed
  5. Encourage passing urine twice at bedtime.
  6. Reassure your child that it is a common problem at this age.

7+years.

Medicines and alarm treatments start to work better from this age with a higher success rate (over 60%).
Treatment can be tailored to the reason why the bedwetting is occurring following results of the assessment and investigations.This could be a bedwetting “alarm”. A neat unit attaching to pyjamas with a lead to a tiny sensor placed between two pars of pants.

Medications are another alternative which work on either of the kidneys to reduce the amount of urine made overnight or on the bladder to prevent overactivity during sleep.
Combinations of the various medicines and alarms may also prove successful.

Where can i get help to treat bedwetting?

Your GP or School Nurse can advise and arrange referral to a clinic.

The views and opinions expressed in this article are the sole responsibility of the author.┬áThe Sheffield Children’s Foundation trust does not accept any responsibility for the content of the above article or the accuracy thereof.