Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK talks about the common myths and facts of bedwetting and how you can contact the team for information and advice. Bedwetting has always been a problem experienced by many children. For some it continues into adulthood. However, this problem, that can have a huge negative impact for many children and families, remains poorly understood. There are many myths about the causes and the treatments that go back to times before modern medicine and research provided a much clearer understanding.

Bedwetting is caused by deep sleep – myth

Most children do not need to wake to pass urine in the night. If a child needs to wee at night, it is either:

• because their body cannot reduce the amount of urine (wee) that they produce overnight (we usually make a lot less wee when we are asleep than we do when we are awake),
• or because their bladder is not able to hold enough urine at night, because it is not working as well as it should,
• or both.

Children wet the bed because they have a problem that means they cannot wake up to signals from the bladder saying that it needs to empty. This is sometimes called ‘lack of arousability’. The bladder still sends those signals to the brain and the signals still disturb the sleep of children who wet the bed, even though the children do not wake up properly and therefore are not able to get up and go to the toilet. However, because the signals are still being sent by the bladder to the brain, children with bedwetting are likely to have poorer sleep quality than children who are dry.

Bedwetting is caused by laziness or naughtiness – myth

Disturbed sleep (from the full bladder signals that are not enough to wake them) makes children feel more tired in the day. The tiredness may affect their behaviour during the day. Children may also become frustrated if they are expected to try and solve a problem that is outside their control. The frustration may make them appear naughty and sometimes makes them try to hide the problems. Some children might hide wet pyjamas or sheets, particularly if they think they are going to get into trouble for the wetting or if they have been teased or bullied about it.

Children do not usually wet their beds when they are awake. If they do this, then it is because they have a different problem that is stopping them getting up and going to the toilet. For some children this may be that they are frightened of going to the bathroom on their own at night. They might find it easier to use a disposable pant or nappy if they wear one, particularly if it is cold when they get up or they have been told off for disturbing other members of their family who are still asleep.

Children should never be punished for wetting the bed. Bedwetting is not caused by something you or they are doing wrong and is not done because the child is being lazy, naughty, or defiant. If you are struggling to cope ask their GP, school nurse or health visitor for help or contact the Bladder & Bowel UK confidential helpline.

Bedwetting is a psychological or emotional problem – possibly

Some children start bedwetting after a traumatic life event. There is some evidence that bedwetting can be linked to psychological and emotional problems. However, this is not the case for most children. It should therefore not be assumed that children are wetting the bed for these reasons.

Bedwetting itself can cause psychological and emotional problems. Therefore, it should never be assumed that a psychological or emotional problem is the cause and that consequently the bedwetting will just get better if the stress goes away. All children with bedwetting should be offered an assessment of their bladder and bowel health to try and work out the cause. They should then be offered treatment to fit their needs and that of their family.

Bedwetting is a developmental problem: it will get better on its own in time – partially true

Bedwetting happens more frequently to younger children. It is thought that a delay in maturity of the systems involved could be the cause in some children. It is also known that some children will just get better with no support. However, children who are wet most nights are the ones who are least likely to get better on their own.

If the bedwetting is upsetting for the child or their family, they should be offered assessment and appropriate support. Bedwetting is considered a medical problem from age 5 years, but there are some simple changes that can be made which may also help younger children.

A simple treatment for bedwetting is waking children for the toilet – myth

There are still many people, including health care professionals who think that waking children to go to the toilet is the right approach to stop bedwetting. While this does work for some, it does not address the underlying problems. Furthermore, many children do not remember being taken to the toilet at night, even if they appear to be awake.

‘Lifting’ or waking a child to take them to the toilet can be useful as a short-term measure to keep a bed dry, for example when on holiday or sleeping at someone else’s house. However, in the long term it does not address the underlying causes and there are thoughts that it may make the problem last longer by encouraging the child to wee when they are not fully awake.

Bedwetting is a common problem in children and is caused by an underlying medical condition – FACT

Today we know that bedwetting is one of the most common medical problems experienced by children. Many children respond well to basic lifestyle changes or simple initial treatments. However, some children and particularly teenagers and young adults need more specialist support to overcome this distressing medical condition.

If you or someone you know is affected by bedwetting, then World Bedwetting Day on Tuesday 26^th May 2020 is ‘Time to Take Action’. You can talk to your child’s GP, school nurse or health visitor. They may be able to refer your child to a local bedwetting or enuresis service. There is information on how to have the conversation with your healthcare professional as well as lifestyle changes you can try at www.stopbedwetting.org. There is also more information on bedwetting on the Bladder & Bowel UK website at www.bbuk.org.uk.

Contact the Bladder & Bowel UK confidential helpline for more advice and information at email bbuk@disabledliving.co.uk or on telephone number 0161 214 4591.