Bladder problems, such as bedwetting and daytime wetting often come hand in hand. Becoming dry at night is a fine balance between how much wee is produced during sleep and the ability of the bladder to store that wee overnight. The crucial factor in all this is the ability of the brain to recognise full bladder signals while the child is asleep. The inability to wake up and go to the toilet at night is often termed ‘lack of arousability’.

There are a number of contributory factors that result in wetting the bed. We now know that around one out of every three children who wet the bed have a problem with their bladder. It is therefore important for all children with a bedwetting problem to have a comprehensive assessment to find out if there is an underlying bladder problem. If there is, this can be treated.

Other main contributory factors include making too much urine during sleep and an inability to wake up to bladder signals indicating the need to wee. We are also aware that underlying constipation and fluid intake can have an impact on the bedwetting as well.

What sort of bladder problems could children have?

Most children’s bladders mature by the time they are 5 years old. By this age, we would expect them to go for a wee between 4-7 times per day. A mature bladder is one that stays relaxed as it is filling (so we only get the feeling we need to wee when it becomes full). It can hold on to the wee until we find a suitable place to empty it. From 5 years old we would expect children to be able to ‘hold on’ when they first feel the need for a wee and get to the toilet on time without getting damp or wet on the way. When they got to the toilet, they should be able to do a full wee and empty their bladder completely.

For some children this does not happen. Their bladder never relaxes while being filled. This is sometimes called a ‘twitchy’ or ‘overactive’ bladder. This results in the child frequently feeling that they need to wee. In some cases, they will have a wetting accident when their bladder suddenly decides it wants to empty, even when it is not full. These children often get little warning that they need to wee and will often have to make frequent dashes to the toilet. This is sometimes termed ‘frequency’ and ‘urgency’.

To stay dry at night, the bladder must be big enough to hold on to wee for 8-10 hours or more. A small bladder can obviously affect the child’s ability to stay dry. Having a small bladder may be because the bladder is not fully mature, but most commonly it is as a result of the child not drinking enough water-based drinks in the day.

A very small number of children may have a problem with not emptying their bladder completely at each wee. This can be as a result of several issues, but the risk is that any wee left behind might become infected. The infected wee often causes the child to want to use the toilet frequently and the wee can become ‘smelly’.

How will I know if my child has a bladder problem?

If your child is over the age of 5 years and keeps dashing to the toilet or has wetting accidents, then it could be a sign of having a bladder problem. Some parents may not consider the odd pair of wet or damp pants during the day to be a problem. They may think their child is ‘lazy’ because they always seem to wait until the last minute to go to the toilet. Other parents may think their child’s wetting problem is because they haven’t toilet trained them properly. Some are too embarrassed to ask for help.

We can check how much a child’s bladder is holding by measuring how much they wee when the go to the toilet. Children are able to hold on to more wee as they get older. To find out how much wee (in ml) your child’s bladder should be able to hold, add 1 to their age in years and then times this by 30 (age in years +1 x 30). For example, if your child is 5 years old 5 +1 = 6, 6 x 30 = 180. Therefore, their bladder should hold 180ml.

Your child may have a problem with their bladder if they are experiencing any of the following problems:

• is weeing less than 4 times or more than 7 times per day
• has some frequency and urgency
• their bladder is holding less than it should be for their age
• they are getting wet or damp during the day

If this is the case, your child may need an assessment and could need subsequent treatment for the problem.

What bladder treatment would my child need?

All children who have a daytime bladder problem should have a management programme that involves:

• regular water-based drinks
• regular toilet visits

You will be told how often they need these by the nurse, but it’s usually around every 2 hours.

How to teach a child to sit on the toilet

Children should also be shown how to sit on the toilet properly. They should have their feet flat (on a step if necessary) and their knees positioned higher than their hips. This allows the pelvic floor to relax and helps the bladder to empty completely. Programmes are individualised to the child and some children may need some medication to control the frequency and urgency and help their bladder relax.

Where can I find further information?

The Bladder & Bowel UK website has a range of downloadable resources for both families and professionals, as well as links to helpful videos. https://www.bbuk.org.uk/children-young-people/children-resources/

The booklet ‘Talk about daytime bladder problems’ can be found at the link below

https://www.bbuk.org.uk/wp-content/uploads/2018/12/Talk-about-Day-Time-Bladder-Problems.pdf

There is information about bedwetting at: https://stopbedwetting.org

For further advice and information, do not hesitate to contact Bladder & Bowel UK via the confidential helpline, 0161 214 4591 or via email: bbuk@disbabledliving.co.uk

This post was written by June Rogers, Children’s Specialist Nurse at Bladder & Bowel UK.