It can be difficult to deal with bedwetting because the child is asleep and are not aware of what is happening. Obviously punishment is pointless, but there are some positive things you can do.
- If your child wants to be dry at night, seek support. This will help stop it becoming a big issue. Involve them in decision making about their treatment including seeking help and the type of treatment.
- Encourage good drinking and toileting arrangements through the day. They should visit the toilet regularly and those visits should be spread.
- Remove obstacles by making it easy for a child to get to the toilet at night. Leave a light on, make sure their path is clear, etc. If they would prefer to use a potty in their room rather than go to the bathroom, then go with it.
- Take nappies off when you start intervention – don’t send mixed messages.
- Have a bedtime routine which includes going to the toilet which will ensure that the bladder is empty at the start of the night.
- Suggest that if they wake up in the night it might be because they need to go to the toilet and it would be worth trying to go.
- Vasopressin is released as part of the winding down process and it’s important to have a good routine and make sure that a child sleeps in a darkened bedroom.
- Keep positive and be supportive.
How do you know you’ve been successful? Fourteen consecutive dry nights is the goal.
Mostly bedwetting is treated by using bedwetting alarms, but sometimes doctors might suggest a drug based treatment. All drugs have side effects and there aren’t any side effects to using the alarms, so it’s no wonder they are the preferred treatment.
What drugs are used to treat bedwetting?
- Anticholinergics like Oxybutynin
Vasopressin is a hormone. It’s released throughout the day, but it peaks at night. It send a message to the kidneys to reduce urine production while we sleep. If there isn’t enough vasopressin, the kidneys continue to produce large amounts of urine and the bladder is unable to hold the volume produced. Vasopressin production is something that happens as part of a child’s development. Each child is an individual and they start producing it at different ages.Desmopressin is the artificial form of vasopressin. It works in a similar way and reduces the amount of urine produced overnight. It is necessary to restrict liquids an hour before taking the medicine and after taking it.
As you’d expect it’s a prescription drug and it’s available in tablet or melt form. The child takes it before they go to sleep and it works for about 8-10 hours. Not every child will benefit from it though. Only a third will find it fully effective and a third will find that it has no effect. The remaining third will get some reduction, but will still have bedwetting episodes. It only replaces the missing hormone and doesn’t stimulate its production. So if a child was dry taking it and stops taking it, they may restart bedwetting. It’s normal to take it for a few months, then stop for a while to see if the body is producing its own vasopressin.
Oxybutynin is a medicine that is used to help an overactive bladder. It helps by relaxing muscles in the bladder which allows it to hold a greater volume of urine. Often it is used in combination with desmopressin.
There are two main treatments for bedwetting: alarms and drug treatments.Generally, bedwetting alarms are the preferred treatments for children who are fine during the day.
A bedwetting alarm requires the child’s full involvement so they do need to be motivated to succeed. Using alarms as a treatment has a good long term success rate. There are two main types of alarm:
- Body worn alarm
- Bed mat alarm
Both alarms work on the same principle: they have sensors that detect when a child has started to wet. The sensor triggers the alarm and the child is woken up. The idea is that their body and mind gradually get used to linking the sensation of a full bladder with the need to wake up to empty it. Gradually they learn either to hold on or to wake up and go to the toilet.
Along the way there should be signs that the alarm is starting to work:
- smaller wet patches
- waking up when the alarm goes
- having more left in the bladder after the alarm has gone off
- alarm getting later in the night
- alarm going off less often
Once they have two consecutive weeks of dry nights then the alarm can be removed. If the alarm is used for three months and there hasn’t been any improvement, then other measures may need to be considered.
Body Worn Alarm
The body worn alarm has a sensor that clips onto tight fitting clothing like underpants, which the child will need to wear each night. You can get alarms that have wire linking to the alarm control box or you can have a wireless alarm, which are considerably more expensive. Often you will get a choice of sounds or a vibration option if you prefer and this might be better if the child shares a room with another. If you opt for sounds, then the machine will randomly choose a sound to stop the child getting too used to a particular sound and tuning it out.
Bed Mat Alarm
Bed mat alarms consist of a foil embossed plastic mat which fits between the sheets over the mattress. The alarm section can either be placed under the pillow and the sound alarm placed beside the bed.