Bedwetting, also referred to as enuresis, is when a child involuntarily empties their bladder whilst sleeping. It is only considered to be a concern once children are over the age of 5, however if children are slower to develop milestones, they may also be delayed in achieving continence. In Australia, around 1 in 5 children experience this.
Bedwetting in children can be attributed to many different factors:
- Inability to awaken due to a full bladder
If children are unable to wake fully due to a full bladder they may experience leakage.
- Poor sleep quality
Poor sleep quality or inability to enter relaxed sleeping can disrupt the production of antidiuretic hormone which is responsible for slowing urine production whilst sleeping. If children are unable to achieve this sleep state, they may produce an increased volume of urine at night which can contribute to bedwetting.
- Small bladder capacity
Children are born with a very small bladder capacity of around 10mLs, and it slowly increases within the first year of life, and also around the age of 3 years. If children have a smaller bladder capacity, it can fill overnight causing leakage. Small bladder capacity can also be due to other causes such as constipation.
- Long sleep duration
Being asleep for a long time means there is more urine production in relation to bladder capacity which can contribute to urinary incontinence.
Due to the close anatomical position of the rectum to the bladder within the pelvis, if constipation occurs, a stool sitting in the rectum may push on the bladder which can reduce bladder volume and cause leakage.
- Result of other condition
There are some conditions in children that can cause incontinence such as infection, kidney disease, diabetes or neurological conditions that may contribute to bedwetting.
At home tips to reduce bedwetting
There are many different strategies that can be used at home to decrease the incidence of bedwetting. Children who wet the bed are not usually lazy or acting out, they may simply be developing at a different rate to other children or be unaware of any issues. Children are often not concerned by bedwetting unless a family member or friend indicates this is a problem. It is discouraged for family and friends to negatively discuss bedwetting or for children to be punished for bedwetting.
If bedwetting develops consistently after a significant period without bedwetting, it may be a sign to get help sooner rather than later.
Tips for home to reduce the incidence of bedwetting can include:
- Having down time before going to sleep.
With current technology so readily available, children may need time to ‘wind down’ for the night before heading to sleep to ensure they achieve good quality sleep. This will assist in optimizing the anti-diuretic hormone that reduces the urine production in the kidneys whilst sleeping.
- Avoid putting a glass of water next to the bed when sleeping
Some children get into the habit of taking a few sips of water every time they wake throughout the night, which can increase urine volume. If children have a smaller bladder capacity or have difficulty waking with a full bladder, this may be contributing to their bedwetting. Slowing water consumption 1-2 hours before sleeping can also assist in decreasing urine production.
- Diet – decreasing bladder irritants and increasing fibre
Foods and drinks which have high acidity, as well as spicey foods can cause irritation to the bladder. In addition, increasing fibre as per recommended guidelines can sometimes assist in reducing constipation.
- Bedwetting alarms
Bedwetting alarms can have a place in treatment for children with ongoing bedwetting issues. They work by helping the child to associate the feeling of a full bladder with arousal from sleeping.
- Increasing abdominal strength
The pelvic floor is developed in combination with abdominal strengthening and positioning. Children who have decreased abdominal strength or poor core stability can benefit from abdominal exercises.
- Treating any underlying conditions
Urinary tract infections, obstructive sleep apnoea and constipation can sometimes be an underlying cause for bedwetting and can be important to consider in regards to management.
Failing these strategies, or if you want further support in reducing incidence of bedwetting, please get in touch!