Overcoming the Challenges of Bedwetting

Causes of bedwetting, and help for parents
By Sasha Cuff

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Bedwetting is a form of enuresis, or loss of bladder control. According to Dr Margaret Fockema, president of CASA, (Continence Association of South Africa) and vice chairman of the Enuresis Academy of South Africa (EASA), the full medical definition of enuresis is “an involuntary voiding of urine during sleep, with a severity of at least three times a week in children over the age of five, in the absence of congenital or acquired defects of the central nervous system”. 
Trish Holgate, a social worker who specialises in counselling children, says“a child under the age of about four years who is wetting their bed should really not be considered enuretic. While the parent may long for dry sheets, the child may still not have the required bladder control. Even once dryness has been achieved, the odd wet bed can be expected. It should resolve itself by about the age of seven. Achievement of night-time dryness varies enormously, so comparisons should be avoided.”
Primary and Secondary Enuresis
There are two types of enuresis. Primary enuresis refers to when a child has never managed to achieve dryness at night. Dr Jacobus van Dyk, a paediatric endocrinologist explains: “We know that there are three contributing factors, namely going into a very deep sleep and not waking up from the sensation of a full bladder, having a small functional bladder capacity and, thirdly, the over-production of urine while sleeping, known as polyuria, which is caused by a lack of an antidiuretic hormone and affects 60 percent of sufferers.”
Secondary enuresis refers to children who have achieved dryness at night but then begin wetting their beds again. According to Dr Fockema, causes can be constipation, urinary tract infections and congenital defects. “The child needs to be evaluated and secondary causes need to be ruled out. Once these have been eliminated as possible causes, a diagnosis of primary enuresis can be made,” she explains. Interestingly, enuresis is three times more likely to occur in boys and a child is 70 percent more likely to develop this condition if both parents were enuretic themselves, suggesting a strong hereditary link. Some also hold the view that there is an emotional cause for secondary enuresis, says Holgate. “In my experience, the most common cause for secondary enuresis is an emotional crisis that causes anxiety. This crisis can be brought on by any big change such as starting school, moving home, illness, divorce or the birth of a new sibling. Even events that you may consider insignificant may cause a child anxiety. A child who is not able to express anxiety appropriately may well begin bedwetting.”
But Fockema disagrees. “Nocturnal enuresis was once thought to be a psychological condition but studies now indicate that the enuresis itself is likely to be the cause of the emotional problems.” In a recent survey in Denmark children were asked what would be most traumatic for them. They perceived the worst thing that could happen to be losing a parent, but this was followed closely by wetting their beds. Contrary to how it may sometimes seem, a child who wets their bed is not being stubborn, manipulative or “naughty”. “It is not their intention to keep you, the parent, slaving over the washing. If you and your child are battling with this problem, you need to consider possible underlying causes so that they can be addressed. Armed with some understanding, you will feel like you have more of a plan and be able to respond appropriately,” says Holgate.
Bedwetting solutions
Solutions vary, depending on the cause and the nature of the enuresis. Firstly, the attitude of the parent plays a vital role in addressing this problem. “Attacking, shaming or punishing the child will only increase anxiety levels and exacerbate the problem. This then leads to a vicious cycle with both the parent and the child ending up very unhappy and frustrated,” explains Holgate. “Rather, remain emotionally contained and show confidence in the child’s ability to eventually control his bladder function.” Dr Fockema adds: “Often letting your child know that you also suffered from this when you were a child provides comfort and reassurance”.
If you are concerned, let your GP examine your child and advise you of the appropriate steps to take. According to Dr van Dyk, “If the problem is an over-production of urine, medication such as an antidiuretic hormone can be given to slow down urine production at night”. It has an almost immediate effect of reducing urine output and therefore reduces bedwetting. The success rate is as high as 70 percent and it is very effective for special occasions such as sleepovers, when going through the night without wetting the bed is extremely important to the child. However, it has been found that once medication is discontinued, bedwetting usually reoccurs.
Changes in diet can also help. Certain foods such as dairy products, caffeine, carbonated drinks and acidic foods irritate the bladder. Reducing or eliminating these from your child’s diet can be effective. Consider also that a child’s bladder capacity increases by a mere 30ml per year during the first eight years of their life. The actual capacity can be measured by multiplying the child’s age by 30 and then adding 30, to get a volume in millilitres. Try limit fluid intake towards bedtime, but don’t be tempted to cut back during the day as this can lead to dehydration.
A method that is quite successful in stopping bedwetting is the use of a bed alarm. “A bed alarm has excellent results,” explains Dr Fockema. “It consists of a sensor that is placed inside the child’s underclothes and is connected to an alarm that goes off if the child starts to urinate. Many consider this to be the method of choice when treating bedwetting, especially in Europe.”
What we as parents need to keep foremost in our minds is that bedwetting is not bad behaviour that needs to be punished. Each child is different and each will eventually gain total bladder control. With our support and encouragement we can help to make this a smoother, easier process for our children. 


Anonymous wrote 3 years 35 weeks ago

Hi there, I want to get a bedwetting alarm for my daughter. Do bedwetting alarms have a cord from the sensor in the nappy/panties which attaches to the alarm (not ideal!) or are their wireless options? If so, can anyone recommend a wireless option that they've been happy with?

Anonymous wrote 6 years 23 weeks ago

My 7-year-old had never had a dry night. We had tried meds to reduce his urine output at night, which didn't assist, and we had tried the sleep alarm. Nothing helped – he slept right through the alarm! He was still in nappies at night because he also slept right through wetting the bed. Then I was told about a programme where you tell your child to go to the loo every 30 minutes during waking hours, for one full week. If they manage to wee, then you give them a small reward (I used one smartie per wee). If they don't go, no issue. During the second week, you extend the period out to an hour and in the third week, you make it every two hours. You must adhere strictly to the time periods. At the end of the third week, I put him back on the alarm (which I had not used during the ‘brain training’ period). The first night, when it went off, he woke up immediately and went to the loo. Since then he has never wet the bed, and that was over a year ago. It is a schlep to implement the programme (I recommend school holidays, for obvious reasons, as it's difficult to implement the wee times during school and sport), but it is so worth it.

rookaya wrote 6 years 23 weeks ago

Together with alternative therapies like Reiki, emotional freedom technique, which can be helpful to release emotional issues, try crossing over exercises. Crossing over is one of the easiest ways to give better control of bodily functions, concentration, memory and so on.

Anonymous wrote 6 years 24 weeks ago

You can buy a bed-wetting alarm from Ferring. Their number is 012 345 6358. They deliver.

Anonymous wrote 6 years 24 weeks ago

Very interesting article. My son is 5 and half and has perfectly dry nights most of the time (since age 4). His dad has recently been travelling a lot for periods of 2-5 weeks at a time and he only ever wets his bed when his dad is not home. I solve this by doing the nightly lift. When his dad is home we don't have to lift him. That, to me, is purely an emotional/anxiety issue.

Anonymous wrote 6 years 45 weeks ago

I have a 5 year girl who was born 7 weeks prem. She recently stopped wetting her panties during the day but still wets her bed at night. What age are children supposed to stop bedwetting?

admin wrote 6 years 45 weeks ago

We know that some children take longer than others to overcome bedwetting problems. We recommend that you consult with your paediatrician, who will be able to assess the issue for you.

Anonymous wrote 7 years 11 weeks ago

Hi there. Could you advise where one can purchase this alarm? I am based in Durban.

admin wrote 7 years 11 weeks ago

Hi. Check out this online store: http://www.wantitall.co.za/bed-wetting-alarm/All/p1. You could also ask your local pharmacy. They may know of local alternatives.

Anonymous wrote 7 years 49 weeks ago

My son is also eight and he is bed wetting. He is not allowed to take any fluids as from 5pm. I encourage him to use the bathroom before going to sleep and also try to wake him up once a night. However,I am a heavy sleeper and travel a lot on business, which disturbs the routine. Last year he was circumcised and stopped bed wetting - I guess it was from the pain - but then he started after 2 months of dry nights. I am worried that it will affect his confidence. He does not go for sleepovers at his friends houses or school camping trips. Where in Pretoria can one buy a bed alarm for bed wetting?

admin wrote 7 years 49 weeks ago

Thank you for your query. Please scroll further down on this comment thread for a link to an online store that sells bed wetting alarms.

Ina wrote 8 years 3 hours ago

My twee seuntjies is een 4 en die ander een 2. Die een van 2 maak ons wakker in die aand as hy wil peepee, maar die een van 4 kom na my toe as hy klaar sy klere natgemaak het, maar nie die bed nie. Hy het vanoggend vir my gesê, ek slaap nog as ek wil gaan peepee, dan is ek te laat. Hoe kan ek hom help?

Anonymous wrote 8 years 1 day ago

My son is almost 8 years old and a bed wetter. I have tried the tablets that produce the "antiduiretic hormone" – twice. I have tried the bedwetting alarm – but nothing worked! After 6pm in the evenings my son is not allowed any fluids and still sometimes he wets his bed TWICE! Any other solutions for me?

Rookaya wrote 8 years 36 weeks ago

As an educator and complimentary therapist, I have devised a programme called Mindnastics, which helps children with bedwetting, nightmares, behaviour problems etc. I have found that addressing the emotional issues have helped kids overcome bedwetting and other challenges.

Anonymous wrote 8 years 37 weeks ago

An excellent article and congratulations to the author. As a child that wet his bed until almost the age of 13, due to various levels of anxiety, I know how they feel and I know that this will pass.

Anonymous wrote 8 years 37 weeks ago

Our eldest son is nearly 10 yrs old and sleeps very deeply. He goes to the toilet before bed, and then I pick him up and take him to the toilet again when he is fast asleep, two hours later. This prevents a urine build up and he manages to get through the night with a dry bed. He never seems to have a problem when he sleeps out.

Sam wrote 8 years 37 weeks ago

In my experience as a therapist, children who bed-wet are experiencing some form of emotional stress. If one can pinpoint what this is and help a child to acknowledge what they are feeling and support them with love, acknowledgement and care, the bed-wetting will stop almost immediately. Craniosacral therapy is very helpful to children with their bed-wetting woes.

Anonymous wrote 8 years 37 weeks ago

My sister used an alarm for her son; she just phoned someone and it was delivered in two days. I think it only cost about R500 - R550. If anyone wants to know more I can try and get some information from her.

Heinrich wrote 8 years 39 weeks ago

We had our son checked for bladder issues, used medication, and used the alarm. The alarm had the best results in our case.

TClarke wrote 8 years 45 weeks ago

I have tried everything, the bed alarm, the anti diuretic hormone, herbal remedies, restricting fluids from 17h00, toilet breaks twice before bed time, nothing works. My son of 7yrs and daughter of 4yrs, still wet the bed. It is not genetic, they are both deep sleepers, and I have now gotten into a morning routine, of both, washing linen, and taking them to school. We don't make any issues of this. Hopefully with age it gets better...

admin wrote 8 years 50 weeks ago

Here's a link to an online store that stocks various bed wetting alarm products: http://www.wantitall.co.za/bed-wetting-alarm/All/p1

Anonymous wrote 8 years 50 weeks ago

Where in Johannesburg can one buy a bed alarm for bedwetting?

Anonymous wrote 8 years 51 weeks ago

Yes, I'd also like to know where you can get this "bed wetting alarm" from.

Anonymous wrote 9 years 1 week ago

Hi there,
Where in Johannesburg can one buy a bed alarm for bedwetting?

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