Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK, talks about secondary bedwetting along with the advice and information we offer via our website and helpline. Bedwetting is one of the most common medical conditions experienced for children. If a child continues to experience wet nights after their fifth birthday and they are toilet trained in the day they should be offered assessment and treatment. This is usually available from their school nurse or GP. They may also be referred to a local children’s continence service.

Children cannot learn to be dry at night in the same way that they learn to use the potty or toilet during the day. Night time dryness occurs as a result of a developmental process. The kidneys need to be able to reduce the amount of urine produced during the night. This is controlled by a chemical messenger (vasopressin) that is made in the brain. If there is not enough vasopressin the kidneys will make too much urine during sleep. The bladder needs to be big enough and working well enough to hold all the urine that is made during sleep. If there is a problem with either the production of vasopressin or with the bladder or with both, then to remain dry overnight, the brain has to be able to wake the child up when their bladder needs to empty. If the child has a problem that means their brain is not able to wake them up to the bladder signals, often called ‘lack of arousability’, their bed will get wet.

Children who have never been dry at night are said to have primary enuresis

Those who have been dry every night for at least six months and then start to get wet beds have secondary enuresis. Children do not suddenly start to wet the bed for no reason. They do not wet the bed to be naughty, lazy or defiant. If a child has secondary enuresis it is important that they have an assessment of their bladder and bowel health and are offered appropriate support based on the outcome of the assessment.

Bedwetting can start suddenly for a variety of reasons. It may be as a result of trauma, stress or anxiety. These may include experiences such as a car accident, parental divorce, bereavement, moving house or being bullied at school. Secondary bedwetting is a common problem in children who are looked after. This may be because of the stress that resulted in them going into care, or it may happen after family contact. Reduction of the stress may not automatically resolve the bedwetting, although it may help.

Although sometimes healthcare professionals may assume that secondary enuresis is a response to an emotional or psychological problem, this is not always the case. It may be an indication of an underlying medical problem. Constipation is a very common condition in children but is not always easy to diagnose. A common, but less well-known symptom of constipation is problems with wetting, either in the day or at night or both. This may start suddenly and happens because the full bowel is pressing on the bladder.

Another common cause of secondary bedwetting is a urinary tract infection

In children a sudden start to wetting after a long time being dry may be the only sign of an infection. Other causes of occasional wet nights, particularly in younger children may be a change in habits. Having a large drink before bed, including where a child is learning to swim, and drinks some of the pool water may cause bedwetting to start. Fizzy or caffeinated drinks that can irritate the bladder may result in a wet bed. Forgetting to go to the toilet before going to sleep may result in the bladder becoming overfull and having to empty before the morning. Having a snack before bed that includes salty or high protein foods may cause bedwetting to start again, because salt and protein cause an increase in urine production.

Rarely bedwetting may be an indication of a more serious underlying health condition. Children who are developing diabetes become very thirsty, and struggle to be able to concentrate their urine. Therefore, they are likely to need the toilet more often during the day and may be tired and lose weight as well. However, bedwetting might be the first sign of diabetes, although this is a rare condition in children.

Whatever the suspected cause, it is important that any child who suddenly starts to wet the bed again at night after a period of being dry should have an assessment and be offered appropriate treatment based on the outcome of the assessment. The 26^th May 2020 is World Bedwetting Day with the theme this year being ‘Time to Take Action’. Therefore, if you have any concerns about secondary bedwetting do take action and contact your child’s school nurse or GP and ask for help.

Learn more about secondary bedwetting

There is more information about bedwetting available online at www.stopbedwetting.org.uk and on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/children-resources/

Bladder & Bowel UK have a confidential helpline to offer advice and support to anyone affected by bladder and bowel health issues. Contact us on 0161 214 4591 or email bbuk@disabledliving.co.uk