Bedwetting in young people

young people BEDWETTING IN

BEDWETTING HAS ALWAYS BEEN A PROBLEM FOR SOME CHILDREN AND FAMILIES IN ALL CULTURES AND SOCIETIES. PREVIOUSLY IT WAS CONSIDERED THAT CHILDREN WOULD GROW OUT OF THIS IN TIME, THAT IT WAS LINKED TO STRESS OR PSYCHOLOGICAL PROBLEMS AND DID NOT CAUSE LONG-TERM ISSUES, SO DID NOT NEED TREATING. HOWEVER, SINCE THE 1980S IT HAS WIDELY BEEN RECOGNISED THAT BEDWETTING IS A MEDICAL CONDITION FROM THE AGE OF FIVE YEARS OLD AND IS TREATABLE.

While bedwetting is a very common problem in younger children, many people do not realise that it can continue for some into the teenage years and even adulthood. While it is not possible to fully predict who will get dry with time, it is now known that those who are wetting most nights or every night are least likely to become dry with time. Furthermore, many young people find bedwetting embarrassing, distressing and difficult to deal with.

WHAT CAUSES BEDWETTING IN YOUNG PEOPLE?

Bedwetting is caused by a combination of problems: • Not being able to reduce the amount of urine that the kidneys produce overnight. A chemical messenger, called vasopressin, usually gets released at night to tell the kidneys to make less urine than they do during the day. This allows the bladder to hold onto all the urine produced without the need to wake and go to the toilet. If too little vasopressin is made, then the kidneys will make more urine during sleep than the bladder can hold. • Not being able to hold onto all the urine that is made. This may be because the bladder is not big enough, or not working well enough. If the bladder is too small or gets ‘twitchy’ when it fills then it is more likely to empty overnight, even if the kidneys do reduce the amount of urine they make while the young person is asleep. • The brain is unable to wake the young person up, when the bladder signals that it needs to empty. Not being able to wake up to bladder signals is the main reason for wetting the bed. Young people who can wake up to go to the toilet will do so. It is the not being able to wake up that causes the wet bed.

Bedwetting is not caused by anything being done wrong by the young person or their family. However, there are some factors that can contribute to bedwetting. These include not drinking enough during the day, fizzy drinks, and having drinks with caffeine in. Eating salty or high protein foods just before going to sleep encourage the kidneys to make more urine at a time when they should be making less. Forgetting to empty the bladder before going to sleep means that the bladder starts the night already partially full, making wetting more likely. Being constipated, may cause bedwetting or make it worse.

Some young people may have previously been offered support to improve the bedwetting, that has not worked. If this happens, then they are less likely to want to follow suggested treatment, as they may feel that it is unlikely to work. Also, young people have a strong and natural desire to be like others. Having to follow treatment recommendations, may make them feel different and so reluctant to undertake what is being suggested.

Changing routines may help. Things to try include ensuring that the young person is drinking plenty of water based drinks a day (about 1.5 – 2litres a day for most teenage girls and 2 – 2.5litres for most teenage boys – but do ask a dietician for advice if one is involved in their care), that they are avoiding fizzy drinks and ones containing caffeine, including energy drinks, stopping all food and drinks an hour before bed and toileting just before sleep can all help.

If making the above lifestyle changes have not helped, then the young person’s healthcare professional may be able to offer assessment and some treatment, or refer them to an appropriate clinic for this. The most common first-line treatments for bedwetting are an alarm or desmopressin. The alarm works by making a loud noise as soon as the young person starts to wet. This is designed to wake them, so that they can go to the toilet. Over a few weeks most people learn to either sleep through the night without needing to pass urine, or to wake before they are wet. Desmopressin is a melt or tablet that tells the kidneys to make less urine during sleep and is very effective for some people. However, Desmopressin does need to be prescribed and is not suitable for everyone, including those who have overnight feeds or wake for a drink in the night.

About 40 – 60 % of people do not respond to just one treatment for bedwetting. They may need to use both the alarm and the Desmopressin at the same time. Some also need a medication

to help their bladder to hold onto urine better. The medicines usually used are from a group called anticholinergics. Healthcare professionals should be able to discuss the most appropriate treatment(s) and explain what is involved.

It is often assumed that young people with a disability will inevitably have bladder and or bowel issues. While conditions causing these may occur more often in those with additional needs, they are not inevitable. Therefore, assessment and treatment should be offered to all young people who are struggling with bladder and/or bowel control.

Constipation is a common problem for all children and young people and even more so in those with disabilities or sensory processing differences. The full bowel can push on the bladder, increasing the likelihood of urinary problems, including bed wetting. Therefore, all young people with a bladder or bowel problem should be offered an assessment and treatment tailored to their needs. The usual plan would be to improve any constipation and then any daytime bladder symptoms before treating the bedwetting.

Any young person who has been toilet trained for more than six months during the day, should be offered support if they continue to have continence issues at night. Many of those with a disability would be able to use an alarm with support from their family and many would be able to take Desmopressin, although this does need to be prescribed and is not suitable for everyone.

Successful treatment usually results in undisturbed sleep through the night. However, some will continue to need to empty their bladder during the night and needing to do this up to once a night is considered normal. However, for young people who have a physical disability that makes them unable to access the toilet independently, there may be options such as a commode or urinal (female urinals are available for girls). These can be used in bed or in the bedroom and may be more convenient at night for some. The young person’s occupational therapist or other healthcare professional may be able to advise.

It is important to remember that even if a treatment has previously been tried and has not worked, it may be successful when an individual is older. This is because the body changes as the young person grows and develops. Therefore, treatments that did not work before may work well later. Therefore, all options should be discussed with a healthcare professional. They may also be able to refer the young person to a local specialist service.

More information is available from Bladder & Bowel UK, a service of Disabled Living. They provide information that is free to access, download and print about bladder and bowel conditions and management solutions for people of all ages on their website at www. bbuk.org.uk.

There is also information on bedwetting on the Stop Bedwetting website at www.stopbedwetting.org.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this visit www.bbuk.org.uk.

While awaiting assessment and treatment, some families find it helpful to use disposable continence containment products at night. A selection of these are available via the Bladder & Bowel UK shop, accessible through our homepage.

For more information on bedwetting visit www.stopbedwetting.org.

Bladder & Bowel UK supports bladder and bowel health for everyone. For support, or to contact the helpline, visit www.bbuk.org.uk or call 0161 214 4591.

Researchers from the University of Oxford are conducting a study to understand the needs and challenges of urine collection in non-toilet trained children.

If you’ve had to collect urine from a non-toilet trained (pre-continent) child in the past 2 years, please go to our website or contact us. Researchers from the University of Oxford are conducting a study to understand the needs and challenges of urine collection in non-toilet trained children. If you’ve had to collect urine from a non-toilet trained (pre-continent) child in the past 2 years, please go to our website or contact us.