In pursuit of dry nights

by Ruth Nichol / 05 May, 2016
Waking to a wet bed can be a nightmare for older children, but there are ways to stop it happening.
Photo/Getty Images
Photo/Getty Images

Jenny Smith didn’t want to tell anyone her daughter Jess was still wearing pull-up nappies to bed at the age of eight.

“You know how it is when you’re going through something – you think you’re the only family on the planet who has this problem,” says Smith (not her real name).

In fact, her family were far from alone. According to Continence New Zealand, 15% of five-year-olds and 5% of 10-year-olds wet their bed – the equivalent of two or three children in every primary school class. Bed-wetting can continue well into teenage years, with about 2% of 15-year-olds still having problems.

Jess wasn’t bothered about wearing pull-ups, but Smith was worried her daughter would eventually start to find it embarrassing.

“I didn’t want her to be uncomfortable at someone’s house if she went for a sleepover, or have horrible girls teasing her about it.”

After trying – unsuccessfully – to help Jess become dry by waking her and taking her to the toilet at 10 every night, the Smiths bought a bed-wetting alarm to put into her pyjama pants. These alarms have a special moisture sensor, which triggers a bell or buzzer as soon as urination starts, waking the child so he or she can go to the toilet.

Within a couple of weeks, Jess was either waking up and going to the toilet before the alarm went off, or sleeping through the night without urinating.

Mary-Anne Caulfield, a continence nurse adviser with the Bay of Plenty District Health Board, says not all children respond to treatment quite as quickly as Jess did.

“Probably the fastest I’ve seen is two days, but it usually takes about 12 weeks to get completely dry.”

Caulfield, who has helped hundreds of children become dry at night, says bed-wetting isn’t considered to be a problem until a child gets to seven. It often runs in families – if one parent was a bed-wetter, there’s a 44% chance their child will be, too. That increases to 77% if both parents wet their beds as children.

She says there are three main ­reasons children continue to wet the bed after the age of seven. The first is that they are very heavy sleepers who simply don’t wake up when they need to urinate. The second is that they haven’t yet started secreting a hormone called vasopressin, which reduces the amount of urine produced at night.

“There’s no black and white rule about when the hormone comes on board and in some ­children it doesn’t get active until they’re a little bit older.”

The third – and most common – reason is that their bladder capacity is smaller than it could be for their age. “Of the children I work with, probably 80% have low functional bladder capacity.”

So, rather than being able to hold a cup or so of urine in their bladder, they can hold as little as 50ml – not enough to get through the night without having to urinate.

Drinking more may sound like an unlikely solution to the problem, but it’s a successful way to increase bladder capacity and end bed-wetting.

Caulfield says children need to get into the habit of drinking enough to completely fill their bladder – about six or seven glasses of water a day – and of going to the toilet regularly.

“People think bed-wetting is a night-time problem, but it’s affected by what you do during the day.”

Often bladder retraining alone can end bed-wetting. But some children also need to supplement the process with an alarm, though at up to $350 they’re not cheap and only a limited number are available for loan through continence services such as the one Caulfield runs.

She says getting on top of the ­problem requires commitment. At some point during bladder retraining, the pull-ups have to come off so that children get a better sense of when they have urinated, which means wet sheets and extra laundry. And although alarms are very effective, they can be disruptive.

“Often they wake up everyone except the child they’re on.”

But it’s worth perse­vering: “It’s so rewarding to see a child who has worked through it and beaten it and come out smiling.”

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