Bedwetting Treatment

There are a number of bedwetting treatments available to you and your child.  It is important to consider all the options, discuss the options with your partner/other caregivers and with your child. You may decide to hold off on a treatment plan and simply wait until bedwetting issues are resolved or you may use more than one treatment at a time.

Motivation
Bed-wetting treatments
Waiting it Out
Fluid Intake
Success Factors
Tips & Advice
Constipation
Counselling
Medication
Changing Habits and Exercises
Nappies and Pull-ups
Ineffective Treatments
Managing the Laundry
Mattress Protection


Motivation
Your child needs to be very involved in the treatment plan if it is to work. As the treatment progresses, your child will probably have some good and some bad days. Be very positive on the good days, and try not to be negative on the bad ones.

Most children don’t need rewards to encourage them to take part in treatment – the prospect of a regular dry bed is usually enough. Some small treats along the way may be a good idea, but don’t promise them in advance. Rather give them as a little surprise if your child is making some progress. Certainly don’t offer big rewards (eg a new bike) because this can add to the stress associated with treatment, and can be very disappointing if your child should fail to get dry.

It can be helpful to keep a record chart of wet and dry nights. Your child should make the chart themselves, and choose how to complete it. Some children like to put stars or stickers on for dry nights or to colour it in or draw pictures. Choose something that fits in with your child’s interests (eg football stickers). Charts used on their own have little success, but in combination with a bedwetting alarm they can be very useful.

Bedwetting Treatments
The following options apply when the bedwetting is not caused by a medical condition such as an abnormality or diabetes.

Waiting
The simplest “treatment” is no treatment. Once you are convinced there is not an underlying medical problem causing the bedwetting then with time the bedwetting should stop. In other words, since most children outgrow bedwetting, you can simply wait and be patient for your child to stop wetting. You should be prepared to take care of wet sheets and pajamas for an extended period of time. It may take several months or several years. Both the parents and the child must feel comfortable with the decision to do nothing. Oversized pull-ups or nappies can be used but may cause your child to feel like a baby if used routinely for a long period of time.

If the bedwetting continues past 6-7 years of age, you will need to address some of the social issues that may arise because your child wets. Sleepovers and childhood camps may become an issue for you and your child. If at any time you or your child thinks the bedwetting is becoming a problem then you should change your course of action and pursue a “real” treatment.

If you believe bedwetting is harming your child’s self-esteem, social opportunities or relationships with family/friends, then it is time to take action.

Bedwetting Alarms
Bedwetting alarms are considered the most useful and successful way to treat bedwetting. Research has shown these alarms will help more than 80% of children become dry, and most children will then stay dry. This treatment requires a supportive and helpful family and may take 4-12 weeks to work. Every child is different in the length of time it takes.  For some children the alarm can work within days, for other children it can takes weeks. Alarms have good long-term success and fewer relapses than medication.

Bedwetting alarms aim to help your child wake when recognizing the sensation to urinate. When exposed to wetness (urine) the alarm makes a loud noise and vibrates to wake your child. The sound needs to be loud enough and quick enough to wake your child prior to complete bladder emptying. When beginning your child will wet and the alarm will sound. Your child (and you) will wake up and you will need to take him/her to the toilet to completely empty his/her bladder of any “left over” urine. Initially your child is likely to empty his bladder before reaching the toilet, but with practice this should improve.

Using the alarm for days or weeks and waking up just after wetting should eventually “condition” your child to wake up prior to wetting. Once your child establishes a consistent pattern of waking during the night prior to wetting then you will no longer need the alarm. However some children do have relapses and the alarm may need to be used for a short time again to get your child back on track.

Some bedwetting alarms, such as the WetStop3 has a sensor that is attached to the underpants. A cord connects the sensor to an alarm that is secured to the pyjama top or near your child’s ear. Other alarms, such as the Rodger Alarm are wireless and sensors are sewn into the underpants with a small transmitter connected to the waistband of the special underwear.

Purchase a bed-wetting alarm.

Fluid Intake
It can’t be over-emphasised how important it is for a child to have a good daily fluid intake. Fluids are essential for healthy bladders and bowels.

Many children think if they don’t drink in the day they will stay dry at night. But this is not the case, reducing day time drinks will reduce the size of the bladder so it will hold less. As well as exacerbating bedwetting, reducing fluid intake can create a need to go to the toilet very frequently in the day and perhaps lead to an overactive bladder or a urinary tract infection (UTI).

It is important to ensure the bladder is allowed to fill and empty fully during the day and a good toilet routine can help with this. If you have concerns about how much your child drinks or suspect that their bladder is not holding as much as it should, speak to their nurse or GP who can do a bladder capacity check and advise how to increase fluid intake.

Water based drinks are preferable as some drinks such as fizzy drinks, tea, coffee, dark squashes (such as blackcurrant) and drinking chocolate can have a diuretic effect on the bladder causing the need to go to the toilet more often.

Tips and Advice on using Bedwetting Alarms

Success Factors
Tips & Advice
Tips for using the Alarm
Bedwetting alarm advice
Purchase a bed-wetting alarm

Success Factors
Research shows that bedwetting alarms are safe and effective in correcting bedwetting in 50-85% of children. Bedwetting alarms are the most successful of all conventional and commonly used bedwetting treatments. The success rates are, however, dependent on several factors.

The most important factors for success are the amount of parental and child involvement and motivation. Bedwetting alarms usually require parent and child working together to follow through with the routine of setting up the alarm, waking to the alarm sound/vibration and assisting with finishing urination in the toilet. Dependent on your child’s age, overtime they may be able to work through this routine without your assistance and this is quite common.

Tips & Advice
When you first get the alarm home, practice the whole routine a few times. You can use a glass of salty water to set the alarm off instead of urine. Talk over the routine together each night as he or she gets ready for bed.

If your child is a deep sleeper, you may have to wake him or her up when the alarm sounds for the first few nights. Most deep sleepers then get used to waking to the sound of the alarm.

Tips for using the Alarm

  • Motivate your child and get him/her excited about using the alarm.
  • Make setting the alarm part of your every day bedtime routine.
  • Do not skip nights or just use it in special cases.
  • Make sure the alarm is loud enough for you to hear.
  • Make the alarm as comfortable as possible.
  • Do not let the amount or frequencies of wetting discourage you from using it.
  • Make sure the volume and vibration are appropriately set.
  • Make sure the sensor is secure to the underwear in ’line of fire’.
  • Position the wires inside the pajama top.
  • Check the batteries regularly.
  • Show your child how the alarm works and get him/her to set and position it each night.
  • Avoid using diapers or pull-ups—your child should feel the wetness.
  • Give plenty of encouragement and praise.
  • Stick to the plan.

Bedwetting Alarm Advice
When the alarm sounds and it is time to take your child to the toilet make sure they are fully awake. The idea is to teach your child’s unconscious mind to recognise the feeling of ‘having to wee’ and use that recognition to squeeze down on the sphincter muscle.

If your child is in a very deep sleep you will need to wake him up to go. Over 10 to 12 weeks, you should see a gradual reduction in the amount of urine released. Your child will still wet the bed throughout treatment, but they will gradually be able to react and use their sphincter muscles before completely letting go of their bladder until they finally reach the point of complete control.

You may decide to start the treatment of using a bedwetting alarm during school holidays or in the summer when nights are not so cold for you to get out of bed.

Try sharing the ‘getting-up’ during the night with your partner. During this time you will feel tired from the interrupted sleep, but perseverance now will be worth the effort in the long run.

Purchase a bedwetting alarm.

Constipation
Constipation is a medical issue which you should discuss with your General Practitioner (GP). If your child is constipated he may experience stomach pain, accidents and other medical problems that need attention. Constipation is however associated with bedwetting, so by resolving the constipation problem, the bedwetting problem may be helped.

Using a bedwetting alarm (or any other treatment) along with correcting the constipation will be more effective in stopping the bedwetting than strictly addressing the constipation problem alone. There are several ways to address constipation and your General Practitioner (GP) will advise. Diet consisting of increased fiber and fluids may help.

Counseling
Counseling can be extremely helpful for children and parents faced with significant bedwetting problems. Children with learning disabilities, developmental delay, and attention deficit disorders are more likely to wet at night. Professionals that are very knowledgeable about the diagnoses and treatments of these problems can provide significant insight and help parents understand their child’s situation. Professional counseling is very important when psychological problems exist that affect the day-to-day life of a child. Bedwetting can be very closely tied to underlying psychological issues, and for this reason counseling can be very rewarding.

Children who have experienced divorce, death, a new sibling, or a new school can have issues that significantly influence their ability to be dry at night. Family counselors, family physicians, pediatricians, and school counselors can be helpful in identifying or discussing these issues. Once the issues are known, then the child is more likely to get the comfort, attention, and guidance they need in order to better deal with their concerns.

Medical counseling can help parents and families better understand all of the various treatment options available to correct their child’s bedwetting. Bed wetting can be a very confusing issue with many treatment approaches. Families can disagree on the approach and leave the child in the middle without getting a fair chance at any one treatment. With a little guidance, children, parents, and family members can get better results if a trained professional guides them through the options for treatment. Also, since compliance to treatment is very important for success, counseling serves to keep everyone on track so the bedwetting can be corrected more quickly. Seek help from professionals who understand all of the treatment options for bedwetting.

Medications

Most children with bedwetting problems do not need to take medication, but there are some occasions when it can be useful. You should consult with your General Practitioner (GP) to discuss options.

Changing Habits and Exercises
It is important for your child to drink plenty of fluid spread evenly throughout the day. Don’t try to restrict the amount of fluid your child drinks in the evening as this will not help and can even delay the process of getting dry at night. However, don’t give drinks containing caffeine (e.g. coffee, tea, hot chocolate, caffeinated soft-drinks like Coca-Cola etc) late at night.

If you are putting your child in a nappy at night, to save on laundry, then it is unlikely that he or she will become dry while this continues. It is better to do away with the nappy all together, but if you must use one, then at least try without a nappy for a week every couple of months. Nappies cannot be worn while using a bedwetting alarm.

Some doctors recommend bladder awareness exercises. These exercises include learning to resist the immediate urge to urinate, and stopping and starting the urine flow midstream. Your doctor will recommend and explain these if necessary.

Improving Daytime Toilet Habits

At first you may think your child does not have any daytime issues. However consider the following questions:

• Does my child hold her/his urine then wiggle, dance or hold him/herself?
• Are there times when my child has to go the toilet immediately?
• Does my child still have accidents during the day?
• Does my child need to go to the toilet frequently during the day?
• Is it difficult to get my child to go to the toilet when they need to?
• Does my child dribble before/after/between toilet trips?
• Has my child had a urinary tract infection?
• Does my child suffer from constipation problems?
• Does my child rush when urinating and may therefore not completely empty his/her bladder?

Poor daytime toilet habits may be one of the most common causes for bedwetting. Some research points to daytime toilet habits as a major contributing factor to bedwetting. Studies have shown that children who wet during the day and those with constipation have a much higher incidence of bedwetting. Children who go often during the day (frequently) or go quickly (urgently) have also been shown to be more likely to wet at night.

Children who really need to urinate during the day can tighten their bottom muscles (sphincter), squat or wiggle, and run to the toilet in order to avoid having an accident. At night, these same children cannot do this since they are asleep and they cannot consciously clench their bottom muscles or run to the toilet. They can get away with holding during the day, but not at night. If a child does not take his time and get all the urine out when he goes to the toilet during the day, he will most likely not completely empty his bladder prior to going to bed. The urine left behind will cause the bladder to fill up more quickly, and while the child is sleeping, the bladder will be more likely to empty.

Tackling some of your child’s poor daytime toilet habits may result in more success during the night. Explain to your child why you wish to take the time to correct some of their daytime toilet habits. Remember that your child needs to ‘buy’ into the reasons in order for them to be motivated to change.

Using a vibrating alarm watch is a great way to remind small children to use the bathroom at regular intervals. Encouraging your child to drink plenty and urinate regularly during the day (when the vibrating alarm reminds them) then you will be on your way to improving their daytime toilet habits. A good vibrating alarm watch from WobL can be purchased here on-line.


Nappies and Pull-Ups
The use of pull-ups and nappies is a debatable topic when discussing bedwetting treatments. It is easier to simply put on absorbent disposable nappies or pull-ups at night time. Many people believe if the child is young, less than 5-6 years of age, then bedwetting is not a significant problem, and it is acceptable to use disposables nappies or pull-ups to avoid wet beds while working through bedwetting issues. If the child is older, it is more difficult to find pull-ups that fit properly. Even as larger pull-ups are becoming available, older children are less willing to wear them because they feel ‘like a baby’. If an older child does not want to wear pull-ups then they should be avoided.

The nappy industry is promoting larger nappies, pull-ups, and disposable briefs for older children with bedwetting and other toilet training problems. Their goal is to sell nappies, not correct the problem. Some disposable products may be helpful but if you are serious about solving bedwetting problems then you are likely to have more success if you stop using nappies and pull-ups.  This of course will require more laundry and time. If planned carefully the work and frustrations can be minimized.

Ineffective Treatment Options

Dry Bed Training
Dry bed training consists of a strict schedule of waking the child at night, attempting to condition the child into waking by himself/herself. Studies show this training is ineffective by itself and does not increase the success rate when used in conjunction with a bedwetting alarm.

Star Charts & Incentive Rewards (used by themselves)
The biggest problem with offering your child a reward for a dry bed is the fact that they have no control over their bedwetting. In effect you are setting them up for failure and disappointment.

As a parent you must approach rewards and star charts for dry nights carefully. It is very important to praise your child if they are doing well and having dry nights. If you are using a star chart in conjunction with another method of treatment such as an alarm then a star chart may act as a motivator, but do use it with caution.


Managing the Laundry
While waiting for your child to stop wetting the bed, you may like to use some protection for the bed. A variety of pads and covers are available to protect the bed and pillow, and there are underwear pads that can be used for special occasions (eg school camps, holidays).

Set yourself up so you can manage the changing, washing and making of the bed as easy and stress-free as possible. Washing sheets, dooner/duvets and blankets on a daily basis can be over-whelming and hugely time-consuming leading to stress and tension in the home.

Make sure you have spare sheets/mattress protectors/pads etc available at all times so changing in the middle of the night or each morning is easier. Try to make the cleaning process as simple as possible.

Consider the following when purchasing products to help you deal with bed-wetting:

  • Quality of material – will this product stand up to daily washing and drying?
  • If I need to wash this product almost every day will it dry quickly?
  • Is it comfortable for my child? Breathable, soft, allergy-free?
  • Is the product easy to fit on the bed?
  • Can my child easily use this product by themselves? (on sleep-overs and school camps)
  • Does this product minimize work, odor and wetness?


Mattress Protection

A waterproof fitted mattress protector (similar to a fitted sheet) will protect your mattress from stains. Choose a waterproof yet breathable mattress protector.