Your child’s treatment plan for bedwetting will depend on a number of factors, such as:
- the frequency of bedwetting
- the impact that wetting the bed is having, both on your child and on you, your partner and other members of your family
- your child’s sleeping arrangements, such as whether they sleep alone or share a room with other children
- whether there's a short-term need to control your child’s bedwetting – for example, if they're going away on a school trip
- how your child feels about specific treatments
Depending on your child’s symptoms and how well they respond to treatment, the person in charge of their care will be their GP or a paediatrician (doctor who specialises in treating children).
Alternatively, many primary care trusts (PCTs) run bedwetting clinics, also known as enuresis clinics, which your GP can refer you to.
There's no single approach to treating bedwetting, but in most cases the recommended plan is to first try a combination of self-help techniques.
If these prove to be unsuccessful, a bedwetting alarm is often recommended. If the alarm proves unsuccessful or is unsuitable, medication may be recommended.
Self-help
A number of self-help techniques may prevent, or at least reduce, episodes of bedwetting. They are discussed below.
Fluid intake
While drinking too much fluid can increase the risk of bedwetting, the same is true if your child doesn't drink enough fluids during the day.
There are several reasons for this. Firstly, not drinking enough fluid during the day can make children very thirsty in the evening, which results in them drinking lots of fluid before going to bed. Secondly, increasing the fluid intake levels to the recommended levels (see below) helps to ‘train’ the bladder to hold an increased amount of urine without triggering the urge to urinate.
The recommended fluid intakes can vary depending on the temperature, your child’s levels of physical activity and diet. However, the following intakes are generally recommended:
- for boys and girls who are 4 to 8 years old, it's recommended that they drink between 1,000 to 1,400ml of fluid a day (1.7 to 2.4 pints)
- for girls who are 9 to13 years old, it's recommended that they drink between 1,200 to 2,100ml of fluid a day (2.1 to 3.7 pints), and for boys of the same age between 1,400 to 2,300ml (2.4 to four pints) of fluids a day
- for girls who are 14 to 18 years old, it's recommended that they drink between 1,400 to 2,500ml (2.4 to 4.4 pints) of fluids a day, and for boys of the same age between 2,100 to 3,200ml (3.7 to 5.6 pints) of fluids a day
As well as the quantity, the timing of fluid intake is also important. Your child should consume most of their fluid intake during the day and only about a fifth of their recommended intake during the evening.
Also encourage your child to avoid drinks that contain caffeine during the evening, such as cola, tea, coffee or hot chocolate because this will increase the need to urinate during the night.
Toilet breaks
Encourage your child to go to the toilet regularly during the day. Most healthy children will urinate between four and seven times a day. You should also make sure that your child urinates before going to bed.
Reward schemes
Many parents find it useful to use reward schemes to help manage bedwetting. However, it's important to emphasise that these types of schemes are only effective when they're designed to promote positive behaviour rather than to punish negative behaviour.
Remember, bedwetting is a symptom over which your child has no control, so it would be inappropriate to give rewards if your child is dry.
For example, you may want to give your child a treat if they:
- stick to their recommended fluid intake over the course of a week
- remember to go to the toilet before going to bed
- taking their medication as required
However, don't punish your child or withdraw previously agreed treats if they wet the bed. Punishing a child is often counterproductive as it places them under greater stress and anxiety, which could contribute to their symptoms.
Bedwetting alarms
If the self-help techniques described above don't help, the next recommended step is to try a bedwetting alarm.
A bedwetting alarm consists of a small sensor and an alarm. The sensor is attached to your child’s underwear and the alarm is worn on the pyjamas. If the sensor starts to get wet, it sets off the alarm. Vibrating alarms are also available for children who are hearing impaired.
You may be able to borrow a bedwetting alarm from your local primary care trust (PCT). Otherwise, they're available to buy commercially. For example, an organisation called Education and Resources for Improving Childhood Continence (ERIC) sells alarms for around £70 to £140, depending on the type of alarm used.
Over time, the alarm should help your child to:
- recognise the need to pass urine
- wake up to go to the toilet
- learn to wake up spontaneously, go to the toilet and stop wetting the bed
You can use a similar reward system as discussed above to promote good behaviour, such as getting up when the alarm sounds and remembering to reset the alarm. To assist your child, you should make it as easy as possible for them to go to the toilet during the night, such as using night lights.
It may take several weeks for you to notice any improvements in your child’s symptoms. If there's no sign of improvement after four weeks, treatment is usually withdrawn as it's unlikely to work for your child.
However, in the long-term, treatment is usually successful, and the majority of children achieve persistent dryness. Treatment with the alarm will usually continue until your child has had at least two weeks of uninterrupted dry nights. If there's no sign of this goal being achievable after three months, treatment is usually withdrawn and replaced by an alternative.
When bedwetting alarms are unsuitable
Bedwetting alarms require considerable commitment from both children and parents. There may be some situations where they're not suitable. For example, if:
- the bedwetting isn't frequent enough (less than once or twice a week) to warrant treatment
- you're finding it emotionally difficult to cope with your child’s bedwetting and a more immediate treatment is required
- there are practical considerations that make using an alarm problematic, such as if your child shares a room with other members of your family or the alarm is causing sleep disturbances
Some children and their parents may also not like the idea of using an alarm to signify when the child has wet the bed.
Medication
Desmopressin
Desmopressin is a synthetic (man-made) version of the vasopressin hormone. It has a similar effect in that it reduces the amount of urine produced by the kidneys. Desmopressin can be used in two ways to treat bedwetting. It can be used:
- to provide short-term relief from bedwetting in situations when this is useful or required – for example, if you're going on holiday or if your child is going on a camping trip with friends
- as a long-term alternative treatment in situations where a bedwetting alarm is ineffective, unsuitable or unwanted
Desmopressin should be taken at bedtime. The medication will lead to a build-up of fluid inside your child’s body so it's very important that they don't drink any additional fluid from an hour before until eight hours after taking desmopressin.
If your child drinks too much fluid during this time period, it could lead to a fluid overload in their body. This could cause a number of unpleasant symptoms, such as headache and sickness.
If your child isn't completely dry after one to two weeks of taking desmopressin, inform your GP or the doctor in charge of your child’s care because their dosage may need to be increased.
Your child’s treatment will then be reviewed after four weeks. If the bedwetting has stopped, or at least their symptoms have improved, it's usually recommended that treatment continues for another three months. If, after this time, there is continuing improvement, the course may continue.
If bedwetting stops while taking desmopressin, withdrawing the medication at regular intervals (one week for every three months) will usually be recommended to check whether they can maintain dryness without taking desmopressin.
If your child fails to respond to either desmopressin or a bedwetting alarm, it's likely that you will be referred to a specialist. A possible option may be to use a combination of a bedwetting alarm and desmopressin.
Anticholinergics
Another option is to use a combination of desmopressin and an additional medication known as an anticholinergic. An anticholinergic called oxybutynin can be used to treat bedwetting.
Oxybutynin works by relaxing the muscles of the bladder, which should improve its capacity and reduce the urge to pass urine during the night.
Side effects of oxybutynin include:
These side effects should improve after a few days once your child’s body gets used to the medication. If they persist or get worse, you should contact the doctor in charge of your child’s care for advice.
Imipramine
If your child fails to respond to any of the treatments discussed above, a prescribed medication called imipramine may be recommended.
Imipramine works in a similar way to oxybutynin in that it relaxes the muscles of the bladder, increasing its capacity and reducing the urge to urinate.
Side effects of imipramine include:
- dizziness
- drowsiness
- dry mouth
- headache
- increased appetite
- feeling sick
The side effects of imipramine should improve once your child’s body gets used to the medication. It's important that your child doesn't suddenly stop taking imipramine because it can lead to withdrawal symptoms, such as:
- feeling and being sick
- anxiety
- headache
- difficulties sleeping (insomnia)
Your child’s treatment will be reviewed after three months. Once it's felt that your child no longer needs to take imipramine, the dosage can be gradually reduced before the medication is withdrawn completely.
