Most children who are incontinent only wet at night but a small percentage wet during the day past the age they are expected to be dry. As they get older, most children will become dry, and it is not usual to treat children for bedwetting until they are at least five to seven years old. Most children with incontinence can be helped; very few have significant physical or psychological problems.

What types of incontinence affect children?

• nocturnal enuresis: when a child over the age of five wets the bed
• primary enuresis: when a child has never been dry for longer than six months
• secondary enuresis: when a child has been dry for longer than six months and then begins wetting again. This is usually linked to some kind of emotional disturbance and treatment involves identifying and, if possible, relieving any stress the child is under
• diurnal enuresis: wetting during the day in children over five years of age. Wet pants may occur only occasionally or many times during the day. Some children may have both diurnal and nocturnal enuresis, in which case they are most likely to have primary enuresis.

Bedwetting

Nocturnal enuresis (bedwetting) is the most common form of incontinence in children. At five years of age, 15-20%, or one in five children still wet their beds at night. This drops to 5% among 10 year olds. Despite treatment, 1- 2% of 15 year olds will still regularly wet the bed at 15 years: this may continue into adulthood.

What causes it?

There is no single cause for enuresis in children past the age of expected bladder control. There is a large variation in the way children develop: just as some children walk at nine months and others at 18 months, some children take longer to control their bladder than others. Some families have a history of bedwetting. If one parent wet the bed as a child, there is a 40% chance of their child wetting the bed until a similar age. If both parents wet the bed, there is an 80% chance of bedwetting in their children. It is rare for physical or structural defects to cause enuresis.

Children who wet their beds are often thought to be deeper sleepers than other children. However, the problem is more likely to be difficulty in arousal or waking from sleep.

Some children who wet repeatedly at night may have insufficient urine concentrating hormone (ADH) and produce large amounts of weak urine overnight. These children can stay dry if they are able to wake at night to go to the toilet when their bladder is full. Children with a small bladder capacity will usually also have problems with daytime wetting.

Can emotional upset cause bedwetting?

Occasionally children wet because of emotional stresses such as parental separation, a new baby, sickness or problems at school. These can cause secondary enuresis but not usually a factor in primary enuresis. Treatment should include identifying and if possible relieving the child's stress.

What treatments are available?

First, seek help from your GP. Every incontinent child should be examined by their doctor to ensure there are no structural problems or a urine infection. Further assessment by a paediatrician, enuresis clinic (if available in your area) or continence adviser (a nurse or physiotherapist with special expertise in continence management) may be needed to work out a programme that is most suited to your child and family.

Both children and parents can benefit from regular support from a suitably qualified health professional. Most training programmes for children are not successful until the child wants to be dry - in other words when they perceive it as a problem. This is usually after the age of seven. It is important to explain to children they are not alone and that the problem will get better in time. Try not to be angry or anxious, children often feel the same way! Try to help them relax and reassure them they are not 'babies', and that you understand it is not a deliberate act of laziness.

What do the programmes entail?

• monitoring fluid intake: it is important to ensure that your child drinks adequately (at least one litre a day) and regularly. Some drinks such as tea, coffee and some fizzy drinks (particularly cola) can irritate the bladder, and it is worth cutting these out to see if it makes a difference
• rewards: a system of stars or other rewards is not helpful in isolation and needs to be designed so the child succeeds at least some of the time
• bladder training: this may be helpful if investigations have established the child has a small bladder for their age. The purpose is to increase the amount the bladder can hold by stretching it a little at a time. It involves regular drinking and encouragement to 'hold on' for gradually longer periods during the day, thereby gently stretching the bladder and gradually making it easier to hold on to larger volumes. Regular measurement of urine volumes passed (a bladder diary) will help monitor the progress of the training and give the child encouragement.
• enuresis alarm (bed buzzer): these can be a very effective method of treatment for children who do not respond to simpler measures and continue to wet the bed after seven years of age. There is a high success rate with this form of treatment, but families need to be taught how to use it correctly, and in a supportive manner to benefit the child. The child and parents often need regular support from a suitably qualified health professional.
• medication: there are a number of medications that can help your child stay dry, but none are curative. A child may become dry, but can revert to wetting when the medication is stopped. This is the reason alarm treatment should always be used first. There are side effects with some of these drugs, which will be explained by your doctor should this form of treatment be chosen. It is not good practice to carry a child to the toilet at night. It may reduce the amount the child wets, but will delay the child becoming dry on his or her own.

Original material provided by the New Zealand Continence Association. Edited by everybody.