Bedwetting - Nocturnal Enuresis - Fact Sheet

Bedwetting, also called nocturnal enuresis, has implications, which are often underestimated by both the community and those advising on its treatment. It places a huge burden on the whole family, as any parent of a bedwetting child will testify! Parents often become very distressed and might even suspect that their child is deliberately causing mischief. They are not! Children can become anxious about their own ability to influence the outcome. Try as they might to help, they feel powerless to stop wetting the bed, and in time their self-esteem may even suffer. Sleepovers with friends and school camps can become a source of considerable stress to the child. Many parents become resigned to the fact that they are unable to help their child. Doctors are often dismissive, offering only reassurance that the child will eventually outgrow the problem, when the family requires immediate help. Whilst bedwetting is a very common problem, it is often needlessly tolerated because of a certain reluctance to discuss what is an awkward and embarrassing subject for many people.

Don’t just wait for the problem to stop!

All children are different. Just as most of the developmental milestones vary from child to child, so does continence at night. Two thirds of children will have stopped bedwetting completely by five years of age. One third are still wetting at five, with the frequency varying from occasional bedwetting to wetting every night. If your child is five and still wetting regularly then it is time act. The parent must decide when they are ready to do something about the problem rather than waiting for the child to be ready. The first three steps of our program can be used with children as young as three or four years of age, however, we do not recommend starting a bedwetting alarm until children are about five years old.

Five and six year old children wetting most nights and all children seven years of age and over who are still bed wetting will generally need treatment to cure the problem. They are unlikely to outgrow the problem. Young children who are only wetting the bed occasionally are most likely to outgrow the problem.

Psychological Factors

Bedwetting problems are often attributed incorrectly to psychological problems. In our experience this is rarely the case. On the contrary, bedwetting may be the cause of psychological problems. It may give rise to feelings of shame, guilt, isolation and loss of self-esteem, especially in older children. Following treatment, a child's emotional health improves, as does self-esteem.

Physical Abnormalities

It is very unusual for a child to have a physical abnormality causing the bedwetting problem.

Causes of bed wetting

• Small bladder capacity
  This means the bladder is not large enough to hold all the urine produced overnight;
• Very deep sleep
  This is very common in children who wet the bed. During the night their bladder sends a message to their brain saying it is full. The child needs to wake up and go to the toilet, however they sleep through this signal;
• Large volumes of urine produced at night
  Some children produce double the normal amount of urine at night so that even if their bladder capacity is normal it will not be big enough to hold all the urine they produce. Overnight these children often have abnormally low levels of the hormone vasopressin, also called antidiuretic hormone. Vasopressin is a hormone,which helps to concentrate the urine at night i.e. it reduces the volume of urine. These hormone levels can return to normal with treatment and
• Constipation
  This can lead to pressure building up in the area around the bladder reducing the amount of urine the bladder can comfortably hold. It can also lead to tightening of the muscles, which need to relax so the bladder can empty fully.

Bed Wetting Treatment

What does a successful bedwetting program involve?
The Bedwetting Cured DVD explains how to treat the main causes of bedwetting with a five step program. It includes:

• a drinking program to improve the connection between the brain and the bladder and to gradually increase bladder capacity;
• information on foods and drinks which may be interfering with vasopressin, the hormone which concentrates the urine at night;
• information on the role of constipation;
• how to get the best results with a bedwetting alarm and
• information on medication although medication is rarely needed.

Bed Wetting Enuresis Alarms
The sound of the alarm helps the “I’m full” message get through from the bladder to the brain. It is usually necessary to use the alarm for between four and eight weeks in conjunction with the other steps of the program. It is best to purchase rather than hire an alarm so that if there are any relapses they can be treated immediately leading to a final cure.

All bedwetting alarms are battery operated so there is no chance of an electric shock. Alarms have various sounds. Most emit a siren sound or loud noise when triggered. There is now a new type of alarm, which has the choice of the alarm sound or it can be recorded with the parent's voice. This is a good option for young children who may be frightened by the alarm sound and may not want to use the alarm again. These alarms also have a flashing light and vibration.

Small pin on alarms
We recommend the type of alarm, which pins onto the pyjamas. A lead runs from the alarm to the sensor, which is placed between two pairs of underpants. It will sound with either a recording of the parent's voice or the alarm sound, as soon as the sensor becomes wet, even with a few drops. A waterproof mattress overlay can go under the child to keep the sheets dry, however, it is not connected in any way to the use of the alarm.

Pad and Bell Alarm
The pad goes under the sheet and the large alarm is placed on the bedside table. A lead connects the two. The alarm sounds once the wetness has reached the pad underneath the sheet. These alarms cost about $1000 and so are usually hired meaning that the alarm is often not available if it is needed again for a relapse.

Why Bedwetting enuresis alarms don’t work
Many people have tried alarms previously without success. The common reasons for failure are

• Using an alarm alone without the initial steps of the program;
• Not getting correct instruction. It is necessary for the parent to go into the child’s room when the alarm sounds. They must wake the child if the child doesn’t wake initially and then the child must turn off the alarm and
• Hiring an alarm and returning it before the child is cured. Some programs have a time limit on keeping an alarm. It is necessary to keep the alarm for about 12 months because it is common for a child to have an initial cure and then to have one or two relapses before being completely cured. The alarm must be used again if the child has a relapse.

Is there any medication that can help?
The most commonly prescribed medication for bedwetting is desmopressin, brand name Minirin. It is a synthetic hormone and has similar actions to the hormone vasopressin, (antidiuretic hormone). Desmopressin helps to reduce the volume of urine produced at night. This medication may reduce the number of wet nights in some children and even stop the bedwetting completely in a few. The main problem with desmopressin is that it is very common for the bedwetting to return as soon as the medication is stopped. The bedwetting alarm is more likely than medication to result in a permanent cure.

Does bedwetting run in families?
Yes, there is a tendency for bedwetting to run in families. This does not in any way alter the treatment used to cure the problem.

Will I need to purchase any equipment?
A bedwetting alarm may be needed to cure the problem. Washable waterproof mattress overlays go under the child and prevent the bottom sheet getting wet. Waterproof quilt covers prevent the quilt getting wet and only need to be sponged down. They can be machine washed if necessary.

Teenage and adult bedwetting

Our experience has shown treatment can be just as successful with teenagers and adults. Adults need to be aware that alcohol can contribute to bed wetting by suppressing the hormone vasopressin (antidiuretic hormone), which reduces the volume of urine produced at night. Following treatment it should be possible to consume alcohol and not wet the bed.

Bedwetting – What not to do

• We do not recommend measuring and charting urine and fluid intake. This is time consuming and messy and will only tell you what you will find out very quickly when you start the drinking program;

• Getting children up at night to go to the toilet will not cure the problem even if it leads to a dry bed in the morning;

• We do not recommend holding on as long as possible before going to the toilet as children tend to leave it until the last possible moment to go. It can discourage them from drinking adequately and can also lead to daytime wetting accidents and
• Reducing fluids in the evening without following a comprehensive drinking program will only lead to a thirsty and disgruntled child not a dry bed.

Results

Many parents can hardly believe that their child could be waking to a dry bed every morning. Results from our anonymous survey sent to customers 12 months after purchasing the Bedwetting Cured Kit showed long term results were very good. The worst outcome was a 93% reduction in wet nights and many achieved complete success i.e. no wet nights in the previous six months.