Bedwetting and continence problems

Bedwetting occurs most nights in 15% of five-year-olds and is still a problem for 3% of all 15 year-olds. There are around 750,000 children and young people in the UK who regularly experience problems with continence - that’s 1 in 12 children. Wet beds or wet or soiled pants during the day are a daily occurrence for some families to cope with. The frustration and extra work involved in managing this can put a strain on family life.

However, because it’s a taboo subject, the real figures for older children could be much higher. It’s significant that night-time ‘nappies’ are widely available in sizes to fit children up to 15 years old. There are many different strategies recommended to help parents deal with their child’s bedwetting. Some work for some families, not for others and there seems to be no definitive cure. Wet beds aren’t just an inconvenience. When an older child is still wetting at night it rules out fun experiences like school trips, sleepovers and can lead to embarrassment and fears about bullying.

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Potty training is the first step to full continence and the journey along this well trodden path will be different for every child - some start early, some later, for some it’s easy but for others it’s a challenge. By offering simple, practical strategies ERIC can help parents overcome any obstacles they face. A frequent question from parents is ‘How do I know when to start potty training?’ A child should be showing some signs that they are ready to start. These signs include managing to stay dry for 1½ - 2 hours, predictable bowel movements, and showing an interest in their own weeing and pooing. 

The usual continence pattern for a child is to gain bowel control at night, bladder control in the day and then bowel control in the day, and finally bladder control at night. When it’s time to say goodbye to nappies at night children feel so proud of themselves and their parents are delighted. But for some children night time dryness isn’t so easy to gain and parents can wonder whether it’s their fault or assume their child is just being lazy. Bedwetting occurs during sleep and for reasons outside of a child’s control – some children produce too much urine at night and may not receive the message that their bladder is full – a child who wets at night is not lazy.

Bedwetting is common in pre-school children and most families begin to look for ways to resolve bedwetting when their child expresses a desire to stop. The age that this occurs varies but it is usually from 5 onwards.  

Top tips to help your child overcome bedwetting

Check it out

If your child is continuing to be wet at night after the age of five, it’s a good idea to have a check-up with your GP to rule out the possibility of any medical causes, such as an infection, which can be easily cleared up with antibiotics. Or speak to your practice nurse or health visitor. 

It’s good to talk

Many children don’t automatically get dry at night, so stay calm and but do talk openly about it. Ensure that they fully understand what it is you’d like them to do, ie. get up and go to the bathroom instead of continuing to wear night-time pull-up pants. Many children simply don’t realise this and it needs explaining to them. 

Anxiety isn’t always the cause

It’s often assumed that anxiety or an emotional reason is the cause of the habit, but this is not always the case, so stay try to stay relaxed about it. After so many years of wearing nappies, some children are simply not used to controlling their bladder and a short period of training will help them to outgrow this habit. 

Stop using nappies and pull-ups at around age 6

Most children become better at staying dry at night around 4 to 5 years old, but every child is different and some can take a little longer. If your child reaches the age of six and is still wearing night-time nappies, it’s good to think about stopping and to protect the mattress with waterproof sheets instead. Your child’s mind is more likely to make that vital mind-body link if the wetness from an accident can be felt against their skin. School holiday times might be better for doing this, when there’s less pressure in the morning to change wet sheets.  

Make an extra toilet visit last thing at night

Encourage your child to ‘double-void’ by having two toilet visits last thing at night, just 10 minutes apart. This will ensure they have emptied their bladder fully. 

Keep well hydrated

Ensure your child is drinking plenty of water throughout the day.  It’s not uncommon to assume that your child needs to reduce their intake of liquid, but constipation is a common cause of bedwetting and increasing fluids throughout the day could sort this out quickly. 

Consider keeping a food diary

Some foods can have an effect on the bladder – perhaps you’ve experienced the changes in the smell and colour of your own urine after eating asparagus or beetroot, for example? Water based fruits and vegetables such as strawberries, melon, grapes, celery and artichokes have a diuretic effect and encourage the body to expel water, so it’s best to avoid eating these in the evening.  Too many sugary drinks and also artificial sweeteners can have the same negative effect.  A food diary can help you make connections between your child’s diet and wet beds. 

Check lighting levels

Keep the route to the bathroom well-lit at night, perhaps leaving a light on in there. However, avoid night-lights in the bedroom itself as your child will experience a deeper, better quality sleep if the room is dark and this alone may ensure a dry night. If your child is worried in the dark, it is possible to buy a night-light with a motion sensor that will automatically come on if your child steps out of bed. 

Remember to stay positive     

The more encouraging and enthusiastic you can be, the easier it’s going to be for your child to get dry at night. Avoid giving any negative feedback – even a raised eyebrow will let your child know that you’re not happy. This will only make it harder for them to succeed, as they will start seeing themselves as a failure. Remind your child of all the other things they successfully learned to do, such as riding a bike, swimming or playing a musical instrument. Some things require a bit of practice to get right and learning how to keep your bed dry at night is just one more of those things.

The tips above have been provided by Alicia Eaton, a Children’s Wellbeing Specialist based in Harley Street and the author of ‘Stop Bedwetting in 7 Days’

Lifting

ERIC (Education and Resources for Improving Child Continence) do not discourage ‘lifting’ (picking your child up during the night and taking him or her to the toilet), but say that it will not help your child to learn when they have a full bladder and wake up or hold on. If you want to ‘lift’, ERIC recommends:

  • Ensuring that your child is awake
  • Waking up your child at a different time each night
  • Taking your child to the toilet, even if they are already wet
  • Drinking habits

There’s general agreement that caffeinated drinks, particularly towards bedtime, can make the problem worse. Some organisations recommend enuresis alarms to help your child wake up when they need the toilet. These can sometimes be obtained free from your local enuresis clinic or obtained from the ERIC website. Medication can be prescribed for short term use, such as for short breaks, sleepovers or school trips. Contact your GP for advice or information.

Continence problems

If a child has problems wetting during the day it can be caused by constipation as the full bowel can put pressure on the bladder or a urinary tract infection (UTI) both can give a feeling of always needing to wee. Another cause of daytime wetting is an overactive bladder - the muscles of the bladder contract instead of relaxing whilst filling causing a sudden and urgent need to empty before the bladder is full - resulting in wet pants before a child has managed to get to the toilet. Parents often think their child is leaving it too late to go to the toilet, whereas the child usually has very little time to get to the toilet and a bit of leakage occurs whilst they are trying to get there. 

Constipation often results in leakage and soiled pants. For some children, a painful poo experience can lead to anxiety about having a poo and can make them reluctant to poo causing them to try to hold on to their poo to avoid more pain. Parents often question their parenting skills when their child is constipated – they wonder whether their child’s diet is the cause or that they haven’t potty trained their child properly. Constipation often occurs for no known reason, but a visit to the doctor for medicine to clear the blockage and help things run smoothly again, drinking well and a good daily toilet routine will resolve constipation for most children. 

ERIC can help parents understand what is happening when their child is having difficulties with wetting or soiling and offers information, support and lots of tips to overcome the problems. You can call the ERIC helpline on 0808 169 9949 which is open between Monday to Thursday, 10am to 2pm. A range of free to download leaflets is available on the ERIC website, where parents can also find a wide range of products such as bed alarms and bed protection to purchase to help with the everyday problems of a child who has wetting or soiling problems.

What other parents say about bedwetting

Helen says her daughter, Emma, seven, has just stopped wetting the bed:
“It was a slow process but we cut out drinks after dinner and never used pull-ups. We did, however, use bed mats. Most importantly, we never told her off for wetting the bed as it wasn't her fault. Now she is dry, we continue to limit drinks in the evening and make sure she pops to the loo again when she’s finished reading in bed.”

Carole says: 
“My son, Sam, six, was wet every night until recently. After asking my health visitor for advice, I decided to stop using pull ups to see how we got on. For the first two weeks I was washing his bedding every morning and he was still wet every night and showing no signs of improvement at all. Then, he had a dry night, then another! I think he saw the pull ups as a security thing and without them, the consequences of a wet bed and pyjamas were a rude wake-up call!”

Kylie says: 
“I wet the bed as a child and was determined to help my children cope with it. I remember missing out on school trips away from home and, was bullied about it. The problem is there’s so much conflicting advice out there. My method was to put on night-time pull-up pants for a week if they wet the bed. Then I would take them off to see how they got on. If they wet the bed again then the night time pull up pants would go back on. I didn’t 'lift' the child out for a wee in the night as I did not want to disturb their sleep. The one time I did do this, my daughter got upset, refused to do a wee and then did one once they were back in bed! For all three I used a reward system (star charts, treats, days out etc) with good results. When they cottoned on to it, the wet beds became dry beds!”

Watch this video for more tips and advice 

This article was updated on February 2021 

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