Who suffers from bed wetting?
Wetting during sleep occurs within all cultures and races. There are different perspectives on when this is a problem depending on the environment of the child. Thus the age that parents start to become concerned about their child’s bed wetting varies, depending on the frequency of the problem, and the level of their concern. Generally speaking, parents start seeking assistance when their child is still wetting during sleep more than once a week and they are older than six years of age.
Incidence of bed wetting.
Causes of bed wetting
Below are a few of the most common causes of bed wetting.
All children with nocturnal enuresis have an arousal disorder that interferes with their ability to wake to a full bladder.
Studies show bedwetters have similar sleep patterns to non-bedwetters; however, when arousal levels are compared, bedwetters generally do not “come to the surface” to the same level as non-bedwetters. Treatment with a bedwetting alarm is very effective. The alarm will sound at the moment of wetting, alerting the sleeping brain. Gradually the brain is trained to respond to bladder signals and dryness results. Even the deepest sleepers can learn to hear an alarm.
The keys are a motivation to be dry, an understanding of how the alarm can help them reach their goal, and family support.
A hormone is normally produced during sleep which reduces the volume of urine. This is called anti-diuretic hormone (ADH). In addition to the arousal disorder which affects the brain’s response to bladder signals, about 60% of children with nocturnal enuresis or bedwetting do not make this hormone. Therefore they produce a large volume of urine during sleep, which exceeds their bladder capacity.
However, once the bedwetter has trained their brain with a bedwetting alarm to wake to bladder signals during sleep, they can stay dry – they just need to go to the toilet more often than someone who produces more ADH. Once night control is established, ADH production is often activated.
In addition to the arousal problem which affects the brain response to bladder signals, some bedwetters have a small bladder. A small bladder cannot hold as much urine as a normal sized bladder. Nor can a bladder which has a tendency to go into muscular spasms (irritable bladder). A child with a small or irritable bladder will also need to urinate frequently during the day, often with urgency. A medical assessment should be made if the child suffers from day-wetting.
Recent studies indicate that with some bedwetters, bladder spasms only happen during sleep. Once the bedwetter has trained their brain to wake to bladder signals during sleep with a bedwetting alarm, they can stay dry – they just need to go to the toilet more often than someone with a normal sized bladder. Once night control is established, bladder size will often increase as a consequence.
Children respond to stress in many different ways (eg they may have a ‘sore tummy’, or start behaving badly). Bedwetting can appear as a response to emotional upsets and stresses. This usually occurs in children vulnerable to wetting the bed because of the other factors previously described. Emotional stress can range from a major event such as family breakdown, through to a relatively small event such as a minor illness or accident.
How do bed wetting alarms work?
How can they help your child?
HOW TO TREAT BEDWETTING
- Bedwetting alarms are the most effective treatment for uncomplicated bedwetting.
- Drugs and medication can provide temporary relief from bedwetting for some bedwetters.
- Wait, approximately 15% of bedwetters spontaneously become dry each year. However, there is no way of predicting whether your child will do so.
HOW TO TREAT BEDWETTING
An effective bedwetting alarm will sound at the moment of wetting, thus alerting your child’s sleeping brain. Over time, the brain is trained to be aware of messages from the bladder and maintain control during sleep.
When the moisture-sensitive part of the alarm is wet, the alarm goes off and the bedwetter is woken. The brain responds by sending a signal to the bladder muscles to stop the flow of urine. Gradually a connection between wetting and being woken is made and the bedwetter’s brain learns to “beat the alarm”, ultimately leading to dry nights.
Nearly all bedwetters sleep soundly, but they will learn to hear an alarm if it is an expected part of the training. The key is good preparation, so they know why the alarm is being used, and a motivated child, so they will want to take charge of their wetting and become dry.
Expect an average of 12-16 weeks to reach stable dryness (21 consecutive dry nights). Each child is unique, so the range can be from 4 weeks to 7 months. Below is a generalised pattern of training:
Alarm sounds, parent helps child to wake but the child gets out of bed and turns off the alarm. The bed is wet.
Alarm sounds, parent helps child to wake, the child gets out of bed and turns off the alarm. The bed is damp but not wet.
Child responds to alarm, gets out of bed and turns alarm off . Bed is damp.
Child responds quickly to alarm, so wetting is minimal.
Child “beats” the alarm and is completely dry. Dryness is achieved by either sleeping through the night or waking to go to the toilet during the night.
Child has several dry nights in a row. Wetting episodes with alarm response breaks the run of consecutive dry nights.
Child reaches 14 consecutive dry nights.
Child continues for another 7 consecutive dry nights without using the alarm.
The goal of 21 consecutive dry nights is reached.
If the child is still dry, training is finished. If there is a wet night, resume alarm training.
Once a child has been reliably dry for three consecutive weeks, continued dryness can be expected. However, occasionally bed wetting may start again at some stage. There is often no obvious cause. A relapse can be defined as two or more wet nights within two weeks. A quick ‘refresher course’ with the alarm is usually all that is required to resume dry nights.