Enuresis, or bedwetting is a common condition in children and young people. However, it can be very distressing and frustrating for them and for their families. For many it causes, low self-esteem, can lead to sleep difficulties, and psychological issues and many worry about the possible embarrassment if others finding out.

What is bedwetting?

Bedwetting is a recognised medical condition that results in the bladder emptying during sleep.  It  is also known as enuresis or nocturnal enuresis.  Affected children and young people cannot help the problem. It is not caused by anything they or their family are doing wrong or are not doing.   It is not caused by laziness or naughtiness.

While bedwetting can be made worse by stress, it is not usually caused by this. Rarely it can be linked to other medical conditions. Therefore, if your child has suddenly started wetting after a period of being dry, you should ask their healthcare professional (GP or school nurse) for help and advice.

What causes bedwetting?

There are different causes for bedwetting.  If the  brain is not able to fully wake a child or young person up when the bladder signals that it needs to empty, then the bed will get wet. However, most children and young people can sleep through the night without needing to go to the toilet.

If the bladder is not working well enough to be able to hold all the urine that is made overnight, then it will need to empty during the hours of sleep. If the child or young person cannot wake, the bed will get wet.  Some children with bedwetting also have problems with bladder function when they are awake. These children may experience some urine leaking during the day: they may get damp or wet underwear. Some may go to the toilet more often than usual (frequency) or they may have to get there quickly than usual (urgency). This can appear to families as if they are leaving it to the last minute to go to the toilet, which is not usually the case: it is the bladder ‘twitching’ at any point during filling, which causes a sudden, strong and unexpected need to get to the toilet quickly.

Most children and young people can reduce urine production during the night,  so that the bladder is able to hold all that is produced while they are in bed. However, if the kidneys are making too much urine while the child or young person is asleep and they are not able to wake to the bladder signals, the bed will get very wet.

Is there anything that can be done to help with bedwetting?

Constipation can also cause bedwetting or make it worse. This is because the full bowel can put pressure on the bladder. Therefore, it is important to try to prevent constipation through a good fluid intake, and by encouraging your child or young person to eat a diet that includes plenty of fruit and vegetables. If you think they may be constipated, then speak to their healthcare professional. Constipation in children and young people does usually need to be treated with laxatives.

Drinking well during the day helps the bladder to work well. This in turn helps it to hold urine better during the day and at night. Most primary school age children should be drinking about 1.5litres of water-based drinks a day;  teenage girls should be having 1.5-2 litres and teenage boys 2 -2.5litres a day. Drinks should be divided up so that all children and young people are having a water-based drink about every two hours, or six to eight drinks a day.

Drinks that are fizzy and drinks that contain caffeine, such as tea, coffee, hot chocolate, cola and many energy drinks, should be avoided. This is because fizzy drinks and caffeine can irritate the bladder lining and increase the likelihood of being wet.  Milk is considered a food rather than a drink.

Children should have their last drink of the day about an hour before bedtime. Drinking late in the evening does not give the kidneys enough time to get rid of any excess fluid before sleep, so may make bedwetting worse. However, stopping drinks too early in younger children may make it more difficult for them to drink as well as they should during the day. Young people, who go to bed later, may stop drinks up to two hours before bedtime. 

Emptying the bladder just before settling to sleep is also important, particularly for children who play or read in bed.  Avoiding screens, such as TVs, electronic tablets, computers, phones etc,  just before sleep may also help as the type of light given out by the screens cause unsettled sleep patterns and trick the body into continuing to make wee at the daytime rate, rather than at the lower night time rate.  

A good bedtime routine may also be helpful. Some children and young people are more prone to wetting if they are very tired due to late nights, others are more prone to wetting if they go to bed early, as they are in bed for longer as their bladder may not be able to hold on for this extra time.

Are there any other treatments for bedwetting?

If the measures outlined above do not help, then medication or an alarm may be appropriate. There is a medication called Desmopressin that helps to tell the kidneys to make less urine overnight.  This is available on prescription from your healthcare professional and there is more information about it in the Bladder & Bowel UK leaflet at Understanding Desmopressin (Desmomelt) – for parents and carers.

Alarms are devices that make an intrusive noise when the child starts to wet. They can be attached to pyjamas (body-worn alarms) or have a mat that goes under the top sheet (bed mat alarms). The noise is designed to wake the child as their bladder starts to let go, so that they can get up and go to the toilet. They can take some time to be effective. While it is not clear exactly how they work, they do help some children to learn to wake to the bladder signals, others learn to hold on all night. There is more information about alarms at Using alarms as a treatment for bedwetting – for parents and carers

Some children may need other medication to help the bladder work well and some children need to have more than one treatment. Therefore, bedwetting in children over five years old should be assessed by a healthcare professional.

Why Christmas can be a good time to think about managing bedwetting?

Children and young people usually spend most of the Christmas holidays at home with their family.  Most children need support to establish good drinking and toileting patterns and this is easier when everyone has time at home.  Also, although there may be more sweets and chocolates around, traditional festive foods tend to include lots of fruit and vegetables. These can help to prevent constipation, which may make bedwetting worse.

The holidays can be a good time to start using a bedwetting alarm. The alarm will disturb you and your child or young person when they wet during the night. However, holiday times may allow you and them to catch up with lost sleep, by getting up a bit later in the morning if they do not have to go to school and you do not have to go to work.

If you have tried the initial adjustments to your child’s routine and the bedwetting is not improving and they are over five years old, then you can ask their healthcare professional for assessment and further treatment. 

Where can I find more information about bedwetting?

There is more information about bedwetting on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/resources-for-children/ and in other blogs on the Bladder & Bowel UK website at https://www.bbuk.org.uk/?s=bedwetting.  There is also information on the website at https://stopbedwetting.org/

Where can I get more advice and help?

Your child or young person’s GP, school nurse or health visitor should be able to provide more information and initial assessment. They may be able to refer your child to a local service for support.  You can also contact the Bladder & Bowel UK helpline for free confidential information and advice via the webform at https://www.bbuk.org.uk/helpline-enquiries/ or on the telephone at 0161 214 4591

For more information and resources for professionals working with bladder and bowel issues, visit our professionals’ section here. 

The post Managing bedwetting at Christmas appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults.

What is World Bedwetting Day and why is it important?

World Bedwetting Day was launched by the International Children’s Continence Society and the European Society for Paediatric Urology in 2015. The aim is to raise awareness of bedwetting and its impact on children, young people and their families. Bedwetting is not a trivial condition and not all children get better with time. Those children who are wet five or more nights a week are least likely to get better without treatment. Bedwetting continues to affect about 1 – 3% of teenagers and 0.5 – 1% of adults.

What is bedwetting?

Bedwetting, also known as enuresis or nocturnal enuresis, is the condition of wetting the bed during sleep. It is a recognised medical problem in children who are at least five years old and have been toilet trained during the day.

What causes bedwetting?

It used to be thought that it is a straight-forward condition that would get better on its own, in time. However, it is now known that it can be a complex disorder, which has several different causes.

Bedwetting is not caused by a psychological problem or stress, although these may make bedwetting worse and can arise because of the bedwetting.

• Bedwetting is caused by a combination of:
• The kidneys making too much urine overnight.
• The bladder being too small or not working well enough to be able to hold the urine made at night.
• The affected child or adult not being able to wake up to the messages from the bladder to the brain saying that the bladder needs to empty.

Are there any other problems associated with bedwetting?

Many younger children and their families are not concerned about bedwetting.  However, as children become more socially aware, they can become upset by it. It can affect their self-confidence and self-esteem and their emotional wellbeing. Although children do not wake up when they need to empty their bladder, the messages from the bladder may disturb their sleep, and so have an impact on their day-to-day functioning, including their school performance.

Bedwetting can also be stressful for families. However, it is important to remember that bedwetting is not due to anything you or your child has or has not done. It is a medical condition and not anyone’s fault.

Should we ask for help?

Successful treatment improves brain and psychological functioning, reduces problems with sleep and behaviour, improves self-esteem and reduces stress and embarrassment.  Active treatment, with an alarm or medication, can be offered from five years old with initial lifestyle advice being helpful for many children, including those who have not yet reached their fifth birthday.

Where can we get help and advice?

Your child’s healthcare professional (health visitor, school nurse, or GP) should be able to provide initial advice and support. If the bedwetting does not improve with some simple lifestyle adjustments, then they may be able to discuss options with you or refer you to a local clinic for further assessment and treatment.

Where can I find more information?

Bladder & Bowel UK is a national charity that provides 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 here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action, and contact your healthcare professional if bedwetting is a problem for you or your child.

The post What is World Bedwetting Day and why is it important? appeared first on Bladder & Bowel UK.

You Time To Take Action: World Bedwetting Day 2021

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, you can find advice on bedwetting in children with disabilities. 

What is bedwetting?

Bedwetting is a common childhood problem.  It can affect any child. Bedwetting (sometimes called Nocturnal Enuresis) has a number of different causes. Staying dry at night requires a fine balance between how much urine is produced during sleep and the ability of the bladder to hold all of the urine produced.   If the bladder gets full before morning the child has to be able to wake up to the bladder signals, get up and go to the toilet.  A problem in one or more of those areas can result in the child wetting the bed.

Most children manage to sleep through the night without needing to wake up and pass urine.  This is because they are able to reduce the amount of urine that the kidneys make when they are asleep and their bladders are big enough and work well enough to hold all the wee they do make.

How does bedwetting affect children who have a disability?

Having a learning disability, a physical disability or additional needs does not in itself cause bedwetting. However, bedwetting in children with disabilities affects large numbers of families, and treatment can help to make it better.

Children aged 5 years and older who have a disability, or additional need, who are toilet trained during the day, and who are still wet at night should always be offered help.  Assessments and treatments for bedwetting are available and it is important to understand that children are not able to learn to be dry when they are asleep, in the same way that they learn to use the toilet in the day.

What causes bedwetting in children?

For some children, their bladder is not big enough to hold all the urine they make when they are asleep.  Others have a bladder that is big enough, but it gets ‘twitchy’ and empties before it is full.  Some children are not able to make enough of a chemical messenger called vasopressin.  Vasopressin tells the kidneys to make less wee at night.  If the child is not making enough vasopressin, their kidneys will make much more urine at night than they should, so the bladder will not be able to hold it all.  If they are not able to wake up when their bladder is full, it will empty and the bed will be wet.

Another contributory factor is having a problem with constipation. This is because when children are constipated the bottom part of their bowel (the rectum), which is normally empty, fills up with poo.  The full rectum then squashes against the bladder, giving it no room to fill up with urine.

Children with disabilities and additional needs are more prone to having a problem with constipation than their peers.  Therefore, any child who has a day or night time wetting problem, should always be assessed to exclude constipation as a possible cause.  Constipation is not always easy to diagnose as many children do not have clear symptoms indicating it is present.  However, treatment may help with the bedwetting.

What can we do about bedwetting in children with disabilities?

Fizzy drinks or ones containing caffeine can irritate the bladder.  They can make it more likely to be ‘twitchy’ and therefore cause bedwetting or make it worse.  Not going to the toilet just before settling to sleep, drinking too much before bed or having salty or high protein food before bed can also cause bedwetting.

Things that can help to make bedwetting better:

• Make sure your child goes to the toilet just before they go to sleep
• Encourage your child to drink well during the day. Most school age children should drink about 1.5 litres of water-based drinks a day, divided between six to eight drinks
• Fizzy or caffeinated drinks should be avoided
• Try to stop all drinks and food in the hour before bedtime
• Good bedtime routines and avoiding electronic screens in the hour before bed are important
• Make sure your child is not constipated. Your GP, health visitor or school nurse can provide an assessment and suggest treatment if they are.
• If you use nappies or pull ups for your child at bedtime have a trial of three or four nights without them

If you continue to encounter bedwetting in a child with a disability, ask their GP, health visitor or school nurse about the available treatment options which may be suitable for your child.

Where can I find more information?

Bladder & Bowel UK is a national charity. It provides 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 here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting in children with disabilities and additional needs appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults.

What is bedwetting?

Bedwetting is also known as ‘enuresis’. It happens when someone passes urine during sleep. Traditionally it was thought to be the result of an emotional or psychological problem and treatment was not considered until children were at least seven years old.

It is now understood that bedwetting happens because of a combination of problems. Children who have bedwetting are unable to wake up when their bladder is full. However, most children do not need to wake up during the night to pass urine. This is because they are able to balance producing less urine during sleep with having a bladder that is working well enough to hold onto the urine they do make until morning. If either or both of these are upset, then the child needs to be able to wake to go to the toilet, in order to stay dry. If they are can not do this, then they will wet.

How common is bedwetting in children under five?

Bedwetting is most common in younger children, with as many as one in five children aged 4 ½ years old having at least occasional wet nights. Children who are only wet on some nights may get better with time, but those who are wet every night or most nights are more likely to continue to have the problem.

When can bedwetting be treated?

Bedwetting is now considered to be a medical issue from a child’s fifth birthday and full assessment and treatment should be available from this age. However, families can ask for basic advice and support before this.

What can families do about bedwetting?

There are several things that families can do to improve bedwetting in children of all ages:

• Encourage your child to drink plenty of water-based drinks each day. These will help the bladder to work well and reduce the likelihood of constipation. (Constipation can cause bedwetting or make it worse)
• Avoid giving your child a drink or food in the last hour before bedtime. Drinks and some foods, particularly those that contain a lot of protein or salt can make the bedwetting worse.
• Have good bedtime routines. These include a regular time for going to sleep, avoiding electronic screens and TV for the last hour before bed and going to the toilet just before settling to sleep.

What else can families do for children under 5 years old who are still wet at night?

Toilet training can help the bladder to mature and to hold urine more effectively. If a child has not been toilet trained, including due to disability, then families can ask for support with this. It is possible that toilet training during the day may result in dry nights, over the following six months.

If children are over two years old and have toilet trained, but are struggling to stay dry and/or clean during the day, their healthcare professional may be able to offer some extra assessment and support. Solving the problem that is causing the daytime issues, may help with the night time wetting as well.

For children who have toilet trained, then a trial of at least two or three nights in a row without pull ups or nappies at night is usually suggested. It is a good idea to use a waterproof mattress protector if nappies are not going to be used. If the child is dry or less wet at night, or if the family can manage, then a longer trial without nappies or pull ups could be tried.

If the child wakes during the night, this may be due to bladder signals, so they should be taken to the toilet. However, children should not be woken during the night to use the toilet, nor should they be taken to the toilet without being woken. Although this may help to keep the bed dry if needed (for example when on holiday) it is no longer thought to be helpful as an intervention for bedwetting.

Where can I find more information?

Bladder & Bowel UK is a national charity that provides 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 here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action, and contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting in children under five years old appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021 Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. Here, we discuss some treatment options for bedwetting.

Treatment for bedwetting

Bedwetting (enuresis) is a recognized as a medical condition in children who are at least five years old and have been toilet trained during the day for six months.  It has a number of different causes. These include not waking up to bladder signals, producing too much urine at night (because the child is not able to make enough vasopressin – a chemical messenger that tells the kidneys to make less urine during sleep), and problems affecting how much urine the bladder can hold. Other factors include constipation, what, when and how much your child drinks, and eating just before going to bed.

Why it is important to treat bedwetting

Children who wet the bed usually sleep through their bladder emptying. However, many of them do have disturbed or restless sleep, which can make them more tired than their peers during the day.  This can affect their behaviour and how they perform at school.  Some children who are wet at night are more anxious about having sleep overs or going on overnight trips with clubs or school.  Some children get upset about wetting the bed.

Things to try at home to help with bedwetting

Most primary aged children should be drinking about 1.5litres of water-based drinks a day.  They should have more than this if they are overweight, very active or if the weather or their environment is hot.  Secondary aged girls should be drinking about 1.5 – 2.5litres a day and boys should have about 2.5 – 3litres a day.

Fizzy drinks and drinks containing caffeine can irritate the bladder lining and so should be avoided.

Drinks and food, particularly those high in protein or salt, just before bed can increase the likelihood of wetting. These should be avoided in the last hour before bed.

Going to the toilet just before sleep and having a consistent bedtime routine can also help.  You can also have a trial for a few nights without disposable pull up pants or nappies, if these are used.

What if these things don’t help?

If you have tried or cannot manage the things mentioned above and the wetting continues, then talk to your child’s healthcare professional.  They should be able to offer an assessment and be able to discuss options for treatment of bedwetting.

The treatment chosen will depend partly on the outcome of the assessment and partly on what you and your child feels is likely to be the best option for you.

The first treatments offered are usually either an alarm or a medication called Desmopressin.

Alarms for bedwetting

Alarms are designed to make a noise and wake your child as soon as your child starts to wet. The child would then get up and go to the toilet before settling back to sleep. Alarms are most effective in children whose bladders are working well and who are able and willing to work with them.

The alarm can take several weeks to work. Signs that the alarm is likely to work include seeing at least one of the following in the first three to four weeks:

• Your child waking to the alarm
• Your child managing to pass some urine in the toilet when they wake
• The wet patches getting smaller
• Your child sleeping for longer before the alarm sounds

If there is no progress in the first three to four weeks, your child’s healthcare professional should be able to discuss options with you.

Desmopressin for bedwetting

Desmopressin is a medicine that can help with bedwetting. It is very like the vasopressin that most people produce to tell the kidneys to make less urine. It works by reducing the amount of urine the kidneys make during sleep.

Desmopressin is available on prescription from the age of five. It is usually given at bedtime or up to an hour before and can work very quickly.  It is a safe medicine to use, but children must not drink for an hour before they have it and for eight hours afterwards (they are usually asleep then).  There is more information on desmopressin in the Bladder & Bowel UK leaflet here.

What if the treatment does not Work?

While there are three main causes for bedwetting (not being able to wake to a full bladder, not being able to reduce the amount of urine made overnight, and the bladder not being able to hold onto the urine that is made) there are other factors that have an effect.  Therefore, one treatment on its own will usually be successful for about 60% of children.  40% of children will need to have more than one treatment for bedwetting to help them overcome it.

If your child is still wetting after trying one treatment, they may be offered a different treatment, either instead of the one they have already tried, or as well as that one.  It is important that you talk to your child’s healthcare professional about other options available if the first treatment has not worked. It is also important to know that a treatment that has not worked the first time you try it, may work later.

Where can I find more information?

Bladder & Bowel UK is a national charity. It provides 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 here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

Bladder & Bowel UK produce a free quarterly electronic newsletter for the public called Talk About. Talk About is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive this fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form or phoning us on 0161 214 4591.

This World Bedwetting Day, Take Action. Contact your healthcare professional if bedwetting is a problem for you or your child.

The post Find out more about treatment for bedwetting appeared first on Bladder & Bowel UK.

For World Bedwetting Day 2021, Bladder & Bowel UK are releasing a series of blogs to help increase understanding of a problem that is not often discussed, but causes stress and distress throughout the world to children, young people, and their families as well as some adults. In this blog post, we discuss the important facts of bedwetting. 

What is bedwetting?

Bedwetting is the leakage of urine during sleep. It is also known as enuresis or nocturnal enuresis and is a recognised medical condition. To be diagnosed with bedwetting the person affected must be over five years old. However, support and basic advice for bedwetting is available to families of younger children who are toilet trained in the day.

Does bedwetting get better with time?

Some children will ‘grow out’ of bedwetting. However, not only is it difficult to predict who will get better if no treatment is offered, but it is also not possible to say when the wetting will stop.  There is evidence that children who are wet every night, or most nights are the ones who are least likely to just get better without treatment.

How many children are affected by bedwetting?

The numbers of children with bedwetting does reduce as the children get older.  21% of  four-and-a-half-year-olds are wet less than two nights a week, and 8% are wet more than two nights a week.  At nine-and-a-half years old, about 8% are wetting the bed less than two nights a week and 1 ½% are wet more than two nights a week.

Does bedwetting affect older children and adults?

Bedwetting is not just a problem for younger children. ‘Primary enuresis’, which is the medical term given to bedwetting that has continued since toilet training, affects about 3% of adolescents and about ½ – 1% of adults.

What might become a problem after dry nights?

If bedwetting starts after a child, has been dry at night for at least six months, it is called ‘secondary enuresis’.  Sometimes there is an obvious trigger for this, like a urinary tract infection, but sometimes it is not possible to work out why it has started.   Rarely, there may also be an underlying medical issue, which needs treatment. That is why it is important to discuss any new bedwetting with a healthcare professional.

Is bedwetting a normal part of growing up?

Children cannot learn to be dry at night in the same way as they do during the day. To become dry at night the kidneys have to be able to reduce overnight urine production and the bladder has to be large enough and work well enough to be able to hold all the urine made at night. If these are not happening, the child has to be able to wake to the bladder signals and go to the toilet if they are to stay dry. Many children are not able to do this, so they get wet during sleep.

What treatment options are there for bedwetting?

If there is any constipation this will usually be treated first. That is because a constipated bowel can put pressure on the bladder and cause bedwetting. Daytime problems, such as dampness, wetting, having to get to the toilet in a hurry or using the toilet very frequently should also be addressed as these can affect how the bladder works at night. Many children will be asked to adjust their fluid intake and toileting habits to see if these help. Some children may need medication to treat daytime wetting.

If none of the above help, or if they are not needed, the first treatments offered will usually be either an alarm or a medicine called Desmopressin. Your Healthcare professional will talk to you about the options and help you and your child chose which treatment to try first.

Where can I find more information?

Bladder & Bowel UK is a national charity that provides 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 here. Information on bedwetting is available here.

There is also information on bedwetting on the Stop Bedwetting website. There is information about World Bedwetting Day available here.

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 fill in the form here and ask to be added to the mailing list.

You can contact the Bladder & Bowel UK confidential helpline by filling in the web form and a member of the team will get back to you.

This World Bedwetting Day, Take Action, and contact your healthcare professional if bedwetting is a problem for you or your child.

The post Bedwetting: The facts appeared first on Bladder & Bowel UK.

For children, books help them to understand the world. Not only are picture books fun for children, but they allow the use of more than one sense to understand the story: children hear the words being read to them, they see the pictures and process those to aid understanding, as well as being able to enjoy the smell and feel of the book. If they are cuddled up with an adult, they are also experiencing the security and warmth of being close to someone else.

For children with sensory or processing differences, including those with autism, developmental and learning disabilities, picture books are a particularly useful tool to help them to learn typical behaviours, as well as what is expected of them when they are working on a new skill.

Picture books for children with bladder and/or bowel issues

Bladder & Bowel UK suggest using two different kinds of picture books for children who have bladder and/or bowel issues.

We have two stories that we recommend for National Read a Book Day. Within our children’s resources, our social stories have a single picture on each page and is presented with very few words or a single sentence. The series of pictures provide information about what will happen in a certain situation. In this way the child knows what is going to happen next. Therefore, social stories are useful in development of specific skills, such as toilet training. They explain the sequence of events in toileting in a way that children who struggle to process language can access easily. They help the child understand what is expected of them, at each point. This reduces the stress and anxiety that may arise when their more familiar routine of nappy changing is altered.

Bladder & Bowel UK recommend using social stories as one of the first steps of toilet training for all children. We suggest taking a look at Talk About Toilet Training, available at: https://www.bbuk.org.uk/wp-content/uploads/2016/12/A4-TALK-ABOUT-GOING-TO-THE-TOILET-2017-1.pdf. The link includes information on introducing toilet training for families, as well as social stories and a colouring book for children.

Social stories

Social stories are particularly helpful for many children who find understanding or using language difficult. This includes children with autism, or other processing differences/learning disabilities including Down syndrome. There is more information about using social stories for toilet training in the Bladder & Bowel UK leaflet, Toilet Training Children with Autism and Related Conditions, available from: https://www.bbuk.org.uk/wp-content/uploads/2016/12/Information-for-professionals-and-carers-re-toilet-training.pdf

Metaphorical stories

Metaphorical Stories are a way help to introduce ideas that can be used as a way of learning and of changing unwanted behaviours. They provide different ways of looking at a problem or issue in a way that children should be able to understand. This then allows them to relate the story to their own situation. They always have an ending that helps resolve the problem. It is suggested that the child is encouraged to discuss the main character’s feelings and how the other characters might be able to help. The pictures can be used to start conversations with the child, which may help adults understand the child’s feelings and reasons for any behaviours.

Bladder & Bowel UK have two metaphorical stories available on their website at www.bbuk.org.uk/metaphorical-and-social-stories/. In the story of Elly’s Success, Elly is an elephant who has to learn to hold water in his trunk, so that he can squirt it at the circus clowns and make people laugh. The story tells of Elly’s disappointment that he is not able to hold the water and then his happiness as he achieves success. It is a metaphor for children who need to learn to become dry. The other story is called Henny’s Success, and is about a hen who is unable to lay her eggs in the hen house. It is a metaphor for children who have problems with soiling and need to learn to open their bowels in the toilet.

All the books and leaflets on the Bladder & Bowel UK website at www.bbuk.org.uk are free to download and print. There is also confidential advice and support available on all bladder and bowel issues in children and in adults available from the Bladder & Bowel UK helpline. Please contact us via email: bbuk@disabledliving.co.uk or telephone: 0161 214 4591.

The post National Read a Book Day appeared first on Bladder & Bowel UK.

Dehydration may cause headaches, light-hot headedness, dizziness, lack of energy and make your child more grumpy than usual. It will also cause the wee (urine) to become more concentrated and darker yellow in colour. This is because the kidneys produce less wee as the body tries to hold onto water. Poos will also become drier and harder as the bowels hold onto water. This may cause constipation.

The bladder relies on regular emptying to help prevent urinary tract infections (UTI). If children are not drinking enough, they will wee less than the usual 5-7 times a day, and this may increase their risk of getting urinary tract infections.

Some children may limit their drinks, in the mistaken belief that they will not need to go to the toilet as often (particularly in school). However, the wall of the bladder is very sensitive and can become irritated by concentrated urine. If irritated, it will be less likely to hold on to the wee for a long time and may give the child less notice that they need the toilet. Families will often think their child is leaving going to the toilet until the last minute. They may also see their child ‘dancing,’ crouching, or holding their groin just before going to the toilet. Sometimes the child may end up needing to wee more than seven times a day, or they may get wet on the way to the toilet.

Not drinking very much or passing small amounts of wee frequently, because of bladder irritation or being sent to the toilet too often to try and prevent wetting, means that the bladder does not get an opportunity to stretch properly, so it may be smaller than usual. This can affect a child’s ability to achieve night time dryness as well.

Children who become constipated may also have problems with their bladder. This is because the end of the bowel (the rectum) is normally empty. The sensation of needing to have a poo happens as the poo moves into the rectum. If the signals are ignored for any reason, such as the child being unable to get to the toilet, or not wanting to go for any reason, the poo will stay in their rectum. If they continue to ignore the signals, they will become constipated. The poo that remains in the rectum takes up space that the bladder needs and puts pressure on the bladder, which then needs to be emptied at short notice and more frequently than is usual. If you think your child has a problem with constipation ask your child’s GP for advice.

Constipation may also be one of the causes of night time wetting for some children.  Another cause may be that the bladder is not able to hold as much wee as it should, something that can happen if a child is not drinking well during the day. More wee will be made at night if the child is drinking most of their drinks in the evening. This is one of the reasons why a good fluid intake, evenly spread out throughout the day is so important.

What should children be drinking?

Children (and adults) should be drinking enough water-based fluids that they do not feel thirsty. Children should be having a drink about every 1 ½ to 2 hours, until about an hour before bedtime. This is equivalent to six to eight drinks a day. The healthiest drink is water. The body uses milk as a food, so this is often not counted as part of the daily fluid intake. Fizzy drinks and drinks containing caffeine (tea, coffee, chocolate, cola and some energy drinks) can irritate the lining of the bladder and so make problems worse. They should be avoided.

Younger children need proportionally more water than older children, and older boys need more than older girls. Children who are overweight, who are in hot environments or who are very active need more as well. The recommended intakes of water-based drinks per day are:

• 1 – 3 year olds should have 900 – 1000mls
• 4 – 8 year olds should have 1000 – 1400mls
• 9 – 13 year old girls should have 1200 – 2100mls
• 9- 13 year old boys should have 1400 – 2300mls
• 14 – 18 year old girls should have 1400 – 2500mls
• 14 – 18 year old boys should have 2100 – 3200mls

During the school holidays it is easier to encourage children to drink. Reluctant children may drink more if allowed to chose their cup or glass, add ice cubes to their drinks, or play a game or read with their parents while drinking, or have dedicated drinking times with other family members.

How are children’s bladder problems treated?

Usually the first treatments tried in children with bladder problems are establishing good drinking and toileting routines. This is more difficult to do when children are at school, which is one reason why the summer holidays are a good time to work on bladder health.

What toileting routines help children’s bladder health?

Children with bladder problems should be encouraged to go straight to the toilet as soon as they feel the need to wee. They should also be asked to go to the toilet if their parents or carers notice them ‘dancing’, holding themselves or crouching. A good toileting routine would include them going for a wee about fifteen minutes after a drink, or about every two hours.

When children go for a wee they should be encouraged to relax and stay on the toilet until they are sure they have finished. Girls should sit with their bottom and feet well supported. Boys should stand and relax. They may find it helpful to sit to wee at least once a day, if they have any bladder problems. To poo both boys and girls should sit with their bottoms well supported, their feet flat on a firm surface and their knees higher than their hips. Most children will need a step under their feet to achieve this and many will need an insert seat.

In the summer holidays there is more time for children to get into a good routine of using the toilet, including having a regular time to poo. Children should also have open access to the toilet more often when they spend more time at home. They are not always able to have this at school.

What about treatments for bladder problems?

One of the most common bladder problems is bedwetting. In addition to good drinking and toileting routines during the day, going for a wee just before sleep and avoiding all drinks and food for an hour before going to bed are important. This can be easier to achieve in the summer holidays when there are fewer organised evening clubs and activities.

There are two main treatment options for bedwetting, either medication (usually desmopressin) or an alarm. Following an assessment your healthcare professional will decide with you and your child which would be the most suitable. The alarm is a device that makes a noise when the child starts to wee during sleep. The aim is to wake the child as they start to wet. Over time the child either learns to wake to the bladder signals and is therefore able to get up and go to the toilet, or they learn to sleep through the night, without needing to wee.

As the alarm is designed to wake the child, it will inevitably disturb their sleep. Getting up for school after disturbed nights is difficult. It is also harder to get up when the bedroom is cold, as happens in the winter. Therefore, summer holidays can be a good time to start using an enuresis alarm for children who have issues with bedwetting. It may take up to three months, or sometimes a bit longer, for an alarm to work fully. Therefore, by the time school restarts most children, where the alarm is likely to be successful, are already sleeping for longer before they wet and some may be having more dry nights by the time they have to go back to school.

Where can I go for further support and advice?

Although the summer holidays can be a good time to work on bladder health, by establishing good drinking and toileting routines and starting treatments such as enuresis alarms, families should not delay seeking support and advice if they have concerns at any time of the year.

If you are concerned about your child’s bladder health then discuss these with their GP, health visitor or school nurse. You may also contact the Bladder & Bowel UK helpline at bbuk@disabledliving.co.uk or telephone 0161 214 4591.

There is also lots of information about children’s bladder health and other conditions that affect children’s bladders and bowels on the Bladder & Bowel UK website at www.bbuk.org.uk

The post Improving children’s bladder health during the summer holidays appeared first on Bladder & Bowel UK.

1. FABLE: Your child will tell you when they are ready to toilet train

FACT: Some children will become increasingly aware of when they are doing a wee or a poo. At some point between the ages of two or three, these children will start to let their families know that they need their nappy changed, or even ask to wear washable pants. However, this happens much less often than it used to in the days when all children wore cloth nappies. In the 1960s and 70s most children were toilet trained by the time they reached their second birthday. Now most children are toilet trained at around the age of three years.

Disposable nappies are excellent at what they do: keeping a child’s bottom feeling dry and comfortable when they wee or poo. This allows the child to ignore the sensation of needing the toilet and carry on with what they are doing. They know that they will be changed when their full nappy is noticed.

The signs that many families are told to look for to know their child is ‘ready’ to toilet train do not work with disposable nappies. Things that are often relied on as signs, such as the child indicating they have done a wee or a poo, are not backed-up by research. There is not even agreement from professionals and experts about which of the ‘readiness signs’ are most important, or how many of them should be present.

Looking at it another way, why would a child instinctively want to change something that has worked for them since birth? This is even more true for children with additional needs, who may not understand the social expectation to use a toilet.

The nurses at Bladder & Bowel UK recommend starting to work on the skills for toilet training as your child approaches their second birthday and even earlier than this for children with known additional needs. These skills include learning words for wee and poo, learning to sit on the potty or toilet, recognising the bladder and bowel sensations and eventually getting wee and poo in the right place.

There is lots of information about how to approach toilet training at https://www.bbuk.org.uk/children-young-people/children-resources/

2. FABLE: Toilet training gets easier as your child gets older, particularly if they have additional needs

FACT: Learning how to use the toilet may take children with additional needs longer than their typically developing peers. However, leaving it later does not make the process quicker or more successful. Leaving toilet training until your child gets older may make it even more difficult. This is because your child has had more time learning that the place where they wee and poo is their nappy. It is harder to change habits that have been in place for longer.

There is evidence that early potty training helps the bladder mature. This can prevent problems with the bladder later in childhood. Also, there is a cost saving to families once children are toilet trained: there is no need to buy nappies. It is also better for the environment as nappies are made from oil-based products and end up in landfill.

At Bladder & Bowel UK, we recommend that all children should be supported to start learning the skills for toilet training before they reach their second birthday and by about eighteen months of age for children with additional needs. In this way the toilet training process becomes a normal part of their day.  For children with additional needs the step-by-step approach to toilet training works particularly well. There is information about this in the Bladder & Bowel UK leaflet ‘Toilet training children with special needs’ at: https://www.bbuk.org.uk/wp-content/uploads/2018/03/Information-sheet-re-Toilet-training-children-with-additional-needs.pdf

Bladder & Bowel UK have joined forces with Positive About Down Syndrome to create two closed Facebook pages to support families of children with Down syndrome in the UK to toilet train their children. These are: ‘DSUK Going POTTY?! Toilet training advice & tips 4 children with Down syndrome’ and ‘DSUK Toileting issues 4 children & young people with Down syndrome aged 5+’

3. FABLE: If your child is having problems with wetting it is because they are drinking too much

FACT: The human body is mainly water, so needs us to drink well every day to stay healthy. If children do not drink enough water-based fluids, they are more likely to become constipated. This is because the bowel will take extra water out of our poos, so the poos become hard. Having hard poos stuck in the lower bowel, gives the bladder less space. This can upset the bladder and make it twitchy, which results in wetting.

When humans do not drink enough water their wee becomes stronger (darker yellow). This can upset the lining of the bladder and may also cause bladder twitching which results in wetting.

A good fluid intake keeps poos soft and prevents constipation. It also helps the kidneys to make a greater quantity of wee that is more dilute (pale yellow). Therefore, the bladder is not irritated and gets more exercise, so learns to work better. Regular drinks (about every two hours until an hour before bedtime), followed by regular toilet visits after each drink, can prevent wetting.

Wetting is not caused by drinking too much. However, it can be caused by not drinking enough water-based fluids. Wetting can also be made worse by drinking the wrong things. Fizzy drinks and drinks that contain caffeine (tea, coffee, hot chocolate, cola and many energy drinks) can all make wetting worse. How much children should drink varies according to age.

Suggested intake of water-based drinks per 24 hours by age and sex

(Adapted from CG 111 Nocturnal Enuresis NICE 2010 and American dietary requirements, cited in CG 99 Constipation in Children and Young People, NICE 2010)

For more information on daytime wetting see the Bladder & Bowel UK leaflet ‘Talk About Daytime Bladder Problems’ at https://www.bbuk.org.uk/wp-content/uploads/2018/12/Talk-about-Day-Time-Bladder-Problems.pdf

4. FABLE: Children who get wee or poo in their pants are lazy and/or naughty

FACT: Children are not naturally lazy. They are energetic and love to learn about things that interest them. Children are also not deliberately naughty. They may do things adults do not like, because they have different priorities, or do not understand how things should be done, or are trying to solve a problem the only way they know how.

Children who get wee or poo in their pants nearly always have a bladder or bowel condition. Constipation, which is not always easy to diagnose in children, is nearly always the cause of poo accidents and can be the cause of wetting as well. Bladder twitching can cause children to do the ‘wee dance’, hold their groin, or crouch with their heel against their bottom. Others will appear to run to the toilet at the last minute, or even too late. This is an automatic response to the bladder twitching suddenly and unexpectedly and is not the child being lazy or naughty. Children who wet the bed when they are asleep may only do so on some nights. Again, this is not their fault but is as the result of a bladder and/or bowel problem.

Wetting and soiling (pooing in the pants) are very common in childhood but are not often spoken about. For this reason, many families feel alone. If you are concerned, speak to your child’s health visitor, school nurse or contact the Bladder & Bowel UK helpline at email bbuk@disabledliving/co.uk or telephone 0161 214 4591.

5. FABLE: Bedwetting is caused by children sleeping too deeply

FACT: Bedwetting is caused by children either making more wee during the night than their bladder can hold, or their bladder not working as well as it should while they are asleep. Children who wet the bed are unable to wake fully to the bladder signals, which is why their bladder lets go.

Children who wet the bed often sleep less well than their peers. This is because the bladder signalling that it needs to empty during the night disturbs their sleep, it just does not fully wake the child. This may leave children who have bedwetting more tired the next day and therefore even less able to wake the following night.

An assessment and treatment should be offered to children who have ongoing bedwetting after their fifth birthday. Your child’s health visitor, school nurse or GP should be able to offer some initial suggestions and if these do not help, they should be able to offer treatment or refer your child to a specialist clinic.

There is more information about bedwetting available in the Bladder & Bowel UK leaflet ‘Talk About Bedwetting’ at https://www.bbuk.org.uk/wp-content/uploads/2018/09/Talk-about-bedwetting.pdf

6. FABLE: Laxatives make the bowel lazy

FACT: Constipation can affect up to one-third of children at any time. For about one in three of these, the constipation will continue and become chronic, that is it will last for more than a month.

If constipation continues, it often gets worse as larger amounts of poo get stuck in the child’s lower bowel. The large poos stretch the muscles that line the bowel, so that they become less able to do their job of moving poo towards the bottom.

Laxatives (medicines to help treat constipation) help to clear out any poo that has become stuck inside the bowel. However, if they are stopped too soon the stretched bowel muscles will not have had a chance to recover. Because they are still over-stretched, they are not good at pushing the poo to the bottom, so the poo starts to build up again. This may make it seem as if the laxatives have made the bowel lazy when it is actually that they have not been given for long enough.

It is important to treat constipation with laxatives as soon as you notice a problem with your child. The laxatives should be continued for as long as necessary and only stopped gradually.

There is more information about constipation in the Bladder & Bowel UK leaflet ‘Understanding Childhood Constipation’ at https://www.bbuk.org.uk/wp-content/uploads/2017/11/Understanding-childhood-constipation-leaflet-advice-for-parents-and-carers.pdf

To see the full range of Bladder & Bowel UK’s information leaflets for children and families visit https://www.bbuk.org.uk/children-young-people/children-resources/

For more information and advice speak to your healthcare professional and always follow their advice. You may also contact the Bladder & Bowel UK confidential helpline at email bbuk@disabledliving.co.uk or telephone 0161 214 4591.

The post Children’s bladder and bowel issues: Some fables and facts appeared first on Bladder & Bowel UK.

Bedwetting (enuresis) is now a recognised as a medical condition with a number of different causes. These include not waking up to bladder signals, too much night time wee being produced, and problems affecting how much the bladder can hold. Other factors include constipation, what, when and how much children drink, whether the child snores and diet.

Dryness at night

As a result of the potential different factors the success rates of single line treatments, such as desmopressin or alarm, have on average a success rate of around 60%, telling us that potentially 40% of children will require combined or other initial treatments, aimed at addressing any other contributory factors, to achieve dryness.

Staying dry at night is a fine balance between the volume of night-time urine produced and the ability of the bladder to store that urine until morning. For treatments to be effective all contributary causal factors will need to be resolved. For example, even if a treatment, such as desmopressin, is effective in reducing any over production of wee at night to a ‘normal’ night-time volume, unless the bladder has enough capacity the child will still wet.

This highlights the important of children having a full holistic assessment prior to commencing any treatment to ensure all underlying factors have been identified and can therefore be addressed. This enables a plan of action to be put in place, based on the outcome of the assessment, and can include such things as encouraging more water based drinks, and ensuring the child goes for a wee just before sleep, for example.

Drinks

Recording when, what and how much the child drinks is helpful in identifying if the child is not drinking enough or drinking too much of the wrong type of drink at the wrong time, in the evening for example. The fluid intake needs to be optimized, with water-based drinks encouraged and restriction of carbonated and caffeinated drinks.

Constipation

Also, how often and how much the child wees will help identify if there are any underlying bladder problems and recording bowel movements will help identify if constipation is present. Constipation is often not recognised either by the child or the parent. However, it should always be excluded as, importantly, often bedwetting improves, or even resolves once any underlying constipation is treated. Any bladder or bowel problems should always therefore be addressed first.

Sleep disorders

There is now a clear recognition between sleep disorders and bedwetting. As a result, children who are reported to snore or have episodes of disrupted breathing during sleep should be referred for further assessment.

Role of diet

More recently the role of diet has been considered as a contributary factor for bedwetting, with some discussions regarding the role of dairy-based products on how much wee is produced. Salty foods are also said to cause an increase in wee production. Although the evidence is not clear it might be beneficial to suggest that these foods are restricted in the evening.

Lit screens

Using lit screens for more than two hours at a time has been shown to affect children’s sleep. Although there is currently no agreement regarding the direct impact this has on a child’s bedwetting it would seem sensible to suggest that screens are not used in the hours before bedtime.

Addressing all the potential contributary factors first will give the child the best chance of achieving dry nights.

More advice and information on bedwetting

The Bladder & Bowel UK website has a range of downloadable resources for both families and professionals as well as links to helpful videos.

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

The website www.stopbedwetting.org also has a range of resources to help raise awareness of bedwetting and empower families.

Further information regarding World Bedwetting Day can be found by visiting: https://www.worldbedwettingday.com/

The post Improving treatment outcomes for bedwetting appeared first on Bladder & Bowel UK.