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Bedwetting is a relatively common childhood condition. It occurs when there is an involuntary loss of urine during sleep. The medical name for bedwetting is nocturnal enuresis.

There are two types of bedwetting:

• primary nocturnal enuresis - persistent, involuntary bedwetting during sleep in a child who is five years of age, or over, and has never been consistently dry at night time, and
• secondary nocturnal enuresis - where bedwetting reoccurs (comes back) following a ‘dry period’ of at least six months.

Secondary nocturnal enuresis is often linked to a stressful event, such as bullying at school, or the divorce of a child’s parents.

How Common Is Bedwetting?

Bedwetting can be a disruptive and stressful condition that is thought to affect:

• about 15% of all children,
• about 45% of children with a parent who has also had the condition, and
• about 75% of children with two parents who have had the condition.

Bedwetting Is Not A Child’s Fault

If your child wets the bed, it is important for you to remember that it is not their fault, and that they have no control over it.

You should not punish your child for wetting the bed because doing so can have harmful psychological effects, such as humiliating them and lowering their self-esteem.

There are a number of possible causes of bedwetting (nocturnal enuresis), and sometimes there may be more than one underlying cause. The main causes of bedwetting are described below.

Overactive Bladder
An overactive bladder is a common cause of bedwetting. The bladder becomes ‘twitchy’ and wants to squeeze out urine even when it is not full, or when you are not ready.

An overactive bladder often causes urge incontinence, which is where you have a sudden urge to urinate and you are unable to hold it in.

Underlying Health Conditions
Bedwetting can sometimes also be caused by a number of underlying health conditions. For example, it can be caused by:

• congenital abnormalities - abnormalities that are present at birth, such as ectopic ureter (where the tube through which urine passes does not lead to the bladder), or
• neurological disorders - such as spina bifida  (a condition that affects the development of the spine and nervous system).

Other Causes
Bedwetting can sometimes simply be caused by drinking too much fluid. It can also be the result of a number of chronic (long-term) conditions such as:

• diabetes,
• constipation,
• urinary tract infections (UTIs), and
• emotional problems.

You should take your child to see your GP if:

• they are wetting the bed at night time (nocturnal enuresis) on a regular basis, and/or
• their bedwetting is upsetting them and causing them considerable distress.

Assessing Your Child’s Bedwetting
In order to find out more about your child’s bedwetting, you GP will ask you, and your child, a number of questions. For example, they may want to find out:

• how often the bedwetting occurs
• how much fluid your child drinks before they go to bed,
• how well you and your child are coping with the problem, and
• whether there is anything that is bothering, or worrying, your child, such as being teased, or bullied.

Your GP will also need to know whether your child has ever had a urinary tract infection (UTI), or any other previous health conditions.
Ruling out underlying conditions

To determine whether your child’s bedwetting is linked to a current infection, or health condition, your GP may carry out a physical examination.

They will want to find out whether there are any underlying health conditions that are causing your child’s symptoms, such as diabetes, or a urinary tract infection (UTI).

To do this, your GP will test your child’s urine for a number of substances, such as blood, glucose, and nitrites (chemical compounds). They may also send a sample to a laboratory for further testing.

What's The Treatment?

In children, medical treatment is rarely started before the age of six, but there's plenty the family can try at home. Steps you can take include reassuring the child and explaining that it's a common problem, not done consciously and certainly not naughty.

Don't blame the child or punish them, but take practical steps, such as putting a waterproof sheet on the bed. An enuresis alarm can help condition the child into getting up at night to pass urine. These can be purchased from ERIC (see below) or borrowed from a local enuresis clinic. However, one in three children relapse after a few months.

Medical treatments include antidepressants (used for their affect on enuresis not depression) and nasal sprays of antidiuretic hormone, which concentrates urine at night. They don't cure bed-wetting, but provide temporary relief and are best used on a temporary basis for holidays or sleepovers.

There are also lifestyle changes that prove very effective. These include:

• Avoiding caffeinated drinks
• Drinking enough liquid during the day and not just once home from school (many children hardly drink at all during the day then drink lots once they get home)
• Passing urine twice just before bed - go once, then a second time five or ten minutes later

For more information please contact ERIC (Education and Resources for Improving Childhood Continence) on 08453 708 008 or visit www.enuresis.org.uk.