Childhood Enuresis

Author: Anne Ramus (Continence Foundation of Australia) with Janine Armocida (National Continence Helpline nurse advisor specialising in childhood enuresis)

With young children who often wet the bed, it might be tempting to say “you’ll soon grow out of it” or to dismiss bedwetting as “just a small problem”. The reality is that a child may not grow out of it and constant bedwetting can cause a child to feel distressed or hopeless.

Incontinence touches adults, teenagers or children alike and is upsetting regardless of age. Without professional help for prolonged bedwetting, children’s socialisation and academic performance can suffer. Adolescents who continue to bed-wet may become embarrassed and not want to seek help. Understandably, the long-term effects on lifestyle, mental outlook and self-esteem can be quite significant.

Doctors and allied health professionals dealing with children and parents for whatever reason should be alert to a bedwetting problem so that they can counsel, advise or refer. Here are some key points:

•  Bedwetting in children aged up to five years is considered normal childhood development. After five, the term “nocturnal enuresis” applies.
• Generally, children are not treated if they are younger than about seven years. However, some younger children can be distressed by bedwetting and in this event; early professional advice should be sought. Conversely, in a situation where a child is unaffected by it and only the parent is upset, then it can be difficult to motivate and treat the child.
• For those who continue to wet the bed as adults, it is important they realise help is available and that the problem can usually be resolved. However, addressing the problem sooner rather than later is recommended – it is generally easier to resolve in childhood.
• Bedwetting is often familial. If one parent suffered nocturnal enuresis, their child has about a 40 per cent chance of also having the problem. This increases to more than a 77 per cent chance if both parents were bedwetters.
• Modern disposable pants and nappies are very effective at keeping a child “dry”. Sometimes it is worth trying life without these for a while, so that the child can learn to better recognise and respond to wetness and discomfort.
• Cutting back on daily fluid intake or waking a child during the night for toilet visits is counter-productive.
• If a bed-wetting alarm is being used as a treatment, it is usually a six to eight week program although it can be longer in some cases. A treatment program longer than three months is not common. Individual experiences differ widely, but two to three weeks of dry beds is generally not enough to firmly establish a pattern of success.
• An alarm is a “team” device: it requires a parent to get up to assist the child as necessary whenever the alarm sounds, although the child must be responsible for turning the alarm on and off. An alarm-based treatment program also needs the support and understanding of siblings as they may also be woken up by the alarm and associated activity.
• Dietary changes and improved fluid intake (both fluid type and volume) can be significant factors, for example, having sufficient daily fluids (water is best), cutting back on sugary soft drinks, cola or chocolate-based drinks and milk, plus having “water only” in the evening.
• Constipation (a problem for an increasing number of children) also affects the frequency of dry nights. Constipation should be treated as this alone can cause nocturnal enuresis in some children.
• For children with developmental delay, bedwetting can be a more difficult issue, requiring even more patience and persistence but it can often be resolved with early professional help. Bedwetting problems (and bowel management) deserve expert attention to ensure that children with intellectual and/or physical disabilities achieve dryness and independence as far as possible, as soon as possible.

Unlike nocturnal enuresis, if a child is wetting or soiling during the daytime, there are other issues to be considered. Professional advice should be sought in these cases so that checks can be made for conditions such as urinary tract infection, bladder instability, constipation, or (although rare) other underlying health condition/s. If both are present, the daytime wetting/soiling should be addressed before the nocturnal enuresis.

For more information contact National Continence Helpline 1800 33 00 66.
Nurse continence advisors with information, advice and printed materials about bladder and bowel control across all age groups.

A range of client resources about bedwetting are available free and in quantity to health professionals.