Children and bedwetting or incontinence!

It is not unusual for children of all ages to have toileting issues. it can however be emabarrassing and uncomfortable for them as they get older and start to have sleeopvers, camps and play dates. The information and treatment that is now available for bedwetting, daywetting and soiling is extremely comprehensive. You can usually discuss the issue with your GP or contact a contince nurse or Dr specialist to assist. It is important to support and reassure your child that it is all perfectly normal and everybody is different. Some children just need to put a bit more energy into helping to train their bodies.

Bedwetting (also called nocturnal enuresis) happens when the bladder empties without permission during sleep. Bedwetting is very common with approximately 1 in 5 children in Australia wetting the bed.

Bedwetting is a complex condition that can often be a source of worry for parents and children. For parents, the main concern is often the emotional and social effects on their children. Children can experience feelings of embarrassment that can lead to low self-esteem. There are also other issues of sleep disruption, laundry workload and costs to contend with as well.

Day-time control of the bladder comes before night-time dryness. Most children will be dry through the day by the age of three, and dry at night by school age. It's important to remember that all children development at different rates, and some children may experience accidents from time to time until the age of 7 or 8.

See our Teenagers bedwetting page for information on bedwetting in older children.

What causes bedwetting?

There are three main causes of bedwetting:

the inability to waken to a full bladder
the bladder becomes overactive at night and cannot store urine, or
the kidneys make a large amount of urine at night and the bladder has difficulty holding this.

Bedwetting is NOT caused by:

being young for your age
laziness
bad behaviour
rebelliousness, or
drinking after dinner.

Some illnesses are linked with bedwetting, however most children who wet the bed do not have major health problems.

Visit our tips for parents page for more information.

When should I seek help for bedwetting?

It is important to seek help for bedwetting if:

the child who has been dry suddenly starts wetting at night
the wetting is frequent after school age
the wetting bothers the child or makes them upset or angry, or
the child wants to become dry.

It is best to seek help from a health professional with special training in children's bladders.

To find a service provider in your area visit our continence service provider directory or contact the National Continence Helpline on freecall 1800 33 00 66.

How can bedwetting be treated?

Most children will stop wetting in their own time, however if the child is over the age of 7 or 8, the problem may not get better by itself.

The first step in treating bedwetting is to seek help from a health professional who will check the child to make sure there are no physical causes.

Some common ways of treating bedwetting are listed below.

Bedwetting alarms teach the child to wake up to the feeling of a full bladder using by waking the child with an alarm when they wet the bed. The alarm can be used on the bed or in the child's underpants.
Drugs that change how active the bladder is or cut down how much urine is made through the night can be prescribed, although drugs alone don't often cure bedwetting. Desmopressin acetate is a medication which substitutes a naturally occurring hormone within the body. It reduces the amount of urine produced overnight by the kidneys. This is a prescription medication. Your prescribing doctor will talk to you about the correct use of this drug.

We have a number of fact sheets available for download on bladder and bowel health. Visit our Resources page for a more advanced search or have a look at some of the popular fact sheets below.

If you are caring for a child with special needs and incontinence, practical tips and advice are available to assist you with your care. Read more on caring with someone with incontinence.

Tips for bedwetting children who want to enjoy a sleep over.

Bridge Magazine

Daytime Wetting

Most children have gained daytime bladder control by the age of four. If a child regularly wets during the day after this age professional advice is necessary.

Loss of bladder control during the day can be called daytime incontinence, while loss of bladder control during sleep is called bedwetting (also called nocturnal enuresis). Children can have both day and night wetting.

Why do children wet during the day?

Most wetting occurs because the bladder is not working normally.

Common problems are:

Overactive bladder - this occurs when the bladder has problems storing urine. The child has urgency (bursting) and may leak urine on the way to the toilet. They may also go to the toilet more than eight times per day.
Under-active bladder - this occurs when the child goes to the toilet infrequently (less than four time a day) and sometime urine escapes without any warning as the bladder overfills. Urinary tract infection is common.
Leakage - this can occur if the child is in the habit of putting off going to the toilet and wets when the bladder is overfilled.
Incomplete emptying of the bladder - some children have learned to empty their bladder incompletely and this can also lead to wetting.

Structural problems are rare. However a medical specialist should manage any child identified as having an anatomical or neurological cause for their incontinence.

Day wetting is NOT caused by:

laziness
naughtiness, or
attention seeking.

As a parent/carer what should I do?Seek professional help

But first watch your child and take note of his or her bladder and bowel behaviour over a few days.

How often does your child go to the toilet?
How often is your child wetting?
What happens when they wet?
How often do their bowels open and is it difficult for your child?
How much does your child drink?
What type of fluids is your child drinking and when?

You are now ready to visit a health professional who will undertake the following:

a detailed medical history
a urine test to exclude infection of the urinary tract (bladder and kidneys)
a physical examination of the spine (back) and the bladder opening to exclude any nerve involvement or structural problems
an abdominal examination which may help exclude constipation, and
an ultrasound of the urinary tract.

Soiling

Faecal incontinence Other names: soiling, encopresis

Faecal incontinence is when children who are past the age of toilet training regularly do poos in places other than the toilet. They can’t control when and where the poo comes. It can be very upsetting for children and parents.

Causes of faecal incontinence

A common cause of faecal incontinence in children is chronic constipation. If your child has been constipated for a long time, poo builds up in his rectum, which can cause the rectum to stretch. Your child might lose the urge to go the toilet because his rectum always feels stretched. Then liquid poo might overflow around the old, stuck poo, without your child feeling it or meaning to let it go. Emotional issues, like stress from premature or forceful toilet training or the birth of a sibling, might also lead to faecal incontinence. Other causes of faecal incontinence include rare neurological disorders and abnormalities of the anus. Faecal incontinence is also called soiling or encopresis.

Faecal incontinence is accidental and beyond your child’s control. But it can be difficult to live with, and it’s normal if you find it challenging or upsetting. If this sounds like you, talk to your GP about getting support.

Symptoms of faecal incontinence

Faecal incontinence can range from ‘skid marks’ to larger bits of poo in your child’s underwear. Aside from pooing in places other than the toilet – usually in his underwear – your child might also have symptoms of constipation. These include pain when doing a poo, which can mean she tries to avoid going to the toilet. They might also have tummy pains that come and go, and she might go for long periods between poos. It’s common for children with faecal incontinence also to have daytime or night-time wetting. About 30-50% of children with faecal incontinence have emotional or behaviour problems too.

All children achieve bowel control at their own rate. Faecal incontinence isn’t generally considered a medical condition unless your child is at least four years old.

When to see your doctor

You should see your GP if your child is four years or older and has persistent faecal incontinence or constipation.

Treatment for faecal incontinence or soiling

The treatment for faecal incontinence depends on the cause of the problem. If chronic constipation is the main cause, your doctor will help you work out a treatment plan based on using laxative medications and establishing good bowel habits. You can help your child get into good bowel habits by encouraging him to sit on the toilet regularly and push. It’s good if he can do this for five minutes about 20-30 minutes after he finishes eating breakfast, lunch and dinner. If your child has behaviour problems associated with faecal incontinence, she might need counselling, and group or individual psychotherapy. Regardless of how it’s treated, faecal incontinence usually goes away in most children.

http://raisingchildren.net.au/articles/encopresis.html

https://www.continence.org.au/pages/soiling.html

More information or where to get help.

https://www.continence.org.au/ - Continence Foundation of Australia has some useful links and fact sheets on it's websites as well as a directory of adult and children's services in your local area.

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