Bedwetting - Treating bedwetting

Although most children will stop wetting the bed as they get older, there are a number of treatments that can be tried.

These treatments probably don’t solve the problem, but they can help keep your child dry until they become dry naturally.

Your child's treatment plan

The treatment for your child will depend on a number of things, such as:

• the frequency of bedwetting
• the impact that wetting the bed is having, both on your child and on you, your partner and other members of your family
• your child’s sleeping arrangements, such as whether they sleep alone or share a room with other children
• whether there's a short-term need to control your child’s bedwetting – for example, if they're going away on a school trip
• how your child feels about specific treatments

Depending on your child’s symptoms and how well they respond to treatment, the person in charge of their care will be their GP or a paediatrician (doctor who specialises in treating children).

Alternatively, many clinical commissioning groups (CCGs) run bedwetting clinics, also known as enuresis clinics, which your GP can refer you to.

There's no single approach to treating bedwetting that works for everybody, but in most cases the recommended plan is to first try a combination of self-help techniques.

If these don't work, a bedwetting alarm is often used. If the alarm is unsuccessful or unsuitable, medication may be recommended.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Self-help

A number of self-help techniques may prevent, or at least reduce, episodes of bedwetting. These are discussed below.

Controlling fluid intake

Drinking too much or too little can contribute to bedwetting. Ensuring your child gets the right amount of fluid each day is often recommended.

Although the amount of fluid your child needs can vary depending on things like how physically active they are and their diet, there are some general recommendations for daily fluid intake. These are:

• boys and girls 4 to 8 years old - 1,000 to 1,400ml (1.7 to 2.4 pints)
• girls 9 to 13 years old - 1,200 to 2,100ml (2.1 to 3.7 pints)
• boys 9 to 13 years old - 1,400 to 2,300ml (2.4 to 4 pints)
• girls 14 to 18 years old - 1,400 to 2,500ml (2.4 to 4.4 pints)
• boys 14 to 18 years old - 2,100 to 3,200ml (3.7 to 5.6 pints)

However, it’s important to remember that these are just guidelines and many children do not drink this much.

As well as the quantity, timing is also important. Most of the recommended fluid intake should be consumed during the day, with only about a fifth during the evening.

Also encourage your child to avoid drinks that contain caffeine, such as cola, tea, coffee or hot chocolate because these increase the need to urinate during the night.

Toilet breaks

Encourage your child to go to the toilet regularly during the day. Most healthy children will urinate between four and seven times a day. You should also make sure that your child urinates before going to bed.

Reward schemes

Many parents find reward schemes helpful in managing bedwetting. This is because motivating your child can help bedwetting treatments be more effective.

However, it's important to emphasise that these are only effective when they promote positive behaviour rather than punishing negative behaviour.

Bedwetting is something your child cannot control, so rewards shouldn't be based on whether they wet the bed or not. Instead, you may want to give rewards for:

• sticking to their recommended fluid intake
• remembering to go to the toilet before going to bed

It's important not punish your child or withdraw previously agreed treats if they wet the bed. Punishing a child is often counterproductive as it places them under greater stress and anxiety, which could contribute to bedwetting.

If you have tried using a reward scheme to improve your child’s bedwetting and it has not been effective, there is little point continuing it as it is unlikely to be helpful.

Bedwetting alarms

If the self-help techniques don't help, a bedwetting alarm is usually the next step.

A bedwetting alarm consists of a small sensor and an alarm. The sensor is attached to your child’s underwear and the alarm is worn on the pyjamas. If the sensor starts to get wet, it sets off the alarm. Vibrating alarms are also available for children who are hearing impaired.

Bedwetting alarms are not prescribed on the NHS, but you may be able to borrow one from your local clinical commissioning group (CCG). Otherwise, they're available to buy commercially. For example, an organisation called Education and Resources for Improving Childhood Continence (ERIC) sells alarms for around £40 to £140, depending on the type of alarm used.

Over time, the alarm should help your child to recognise when they need to pee and wake up to go to the toilet.

Reward systems to promote good behaviour may help, such as getting up when the alarm sounds and remembering to reset the alarm. It also helps to make it as easy as possible for your child to go to the toilet during the night, such as using night lights.

The alarm will usually be used for at least four weeks. If there are signs of improvement by this point, the treatment will continue. If there's no sign of improvement, treatment is usually withdrawn as it's unlikely to work for your child.

The aim of the alarm is achieve at least two weeks of uninterrupted dry nights. If there's some improvement after three months, but no sign of this goal being achievable, alternative treatments are usually recommended (see below). 

When bedwetting alarms are unsuitable

Bedwetting alarms require commitment from both children and parents. There may be some situations where they're not suitable. For example, if:

• more immediate treatment is required, for example because you're finding it emotionally difficult to cope with your child’s bedwetting
• there are practical considerations that make using an alarm problematic, such as if your child shares a room or the alarm disturbs sleep

Some children and their parents may also not like the idea of using an alarm to signify when the child has wet the bed.

Medication

If a bedwetting alarm doesn't help or isn't suitable, treatment with medication is usually recommended. The three main medicines used are described below.

Desmopressin 

Desmopressin is a synthetic (man-made) version of the hormone that regulates the production of urine, called vasopressin. It helps to reduce the amount of urine produced by the kidneys.

Desmopressin can be used:

• to provide short-term relief from bedwetting in certain situations – for example, if you're going on holiday or if your child is going on a trip with friends
• as a long-term alternative treatment in situations where a bedwetting alarm is ineffective, unsuitable or unwanted

Desmopressin should be taken just before your child goes to bed.

The medication reduces the amount of urine that your child produces and makes it harder for their body to deal with excess fluid. Therefore, it's important that they don't drink from an hour before until eight hours after taking desmopressin. If your child drinks too much fluid during this time, it could cause a fluid overload leading to unpleasant symptoms, such as headache and sickness.

If your child isn't completely dry after one to two weeks of taking desmopressin, inform your GP because the dosage may need to be increased.

Your child’s treatment should be reviewed after four weeks. If the bedwetting has improved, it's usually recommended that treatment continues for another three months, although your doctor may advise taking desmopressin earlier each night (1-2 hours before bedtime). If there is continuing improvement during this time, the course may continue.

If bedwetting stops while taking desmopressin, the medication is reduced gradually to see if your child can stay dry without taking it.

If desmopressin or a bedwetting alarm doesn't work, you will be referred to a specialist.

Anticholinergics

Another option is to use a combination of desmopressin and an additional medication known as an anticholinergic. An anticholinergic called oxybutynin can be used to treat bedwetting.

Oxybutynin works by relaxing the muscles of the bladder, which can help improve its capacity and reduce the urge to pass urine during the night.

Side effects of oxybutynin include feeling sick, dry mouth, headache, constipation or diarrhoea. Although these should improve after a few days once your child’s body gets used to the medication. If they persist or get worse, contact the doctor in charge of your child’s care for advice.

Imipramine

If the above treatments don't work, a prescribed medication called imipramine may be recommended.

Imipramine also relaxes the muscles of the bladder, increasing its capacity and reducing the urge to urinate.

Side effects of imipramine include dizziness, dry mouth, headache and increased appetite. Although these should improve once your child’s body gets used to the medication. It's important that your child doesn't suddenly stop taking imipramine because it can lead to withdrawal symptoms, such as feeling and being sick, anxiety and difficulties sleeping (insomnia).

Treatment should be reviewed after three months. Once it's felt that your child no longer needs to take imipramine, the dosage can be gradually reduced before the medication is stopped completely.

Treating an underlying condition

If an underlying health condition is the cause of your child's bedwetting, specific treatment will depend on the condition.

Advice for parents

It can be easy for experts to advise parents to remain calm and supportive if their child is bedwetting, but in reality it can be a difficult experience to live with.

While it's important never to blame or punish your child, it's also perfectly normal to feel frustrated.

You should tell your GP if you feel that you need support, particularly if you're finding it difficult to cope.

You may also find it useful to talk to other parents who have been affected by bedwetting. Education and Resources for Improving Childhood Continence (ERIC) has a message board for parents.

The advice below may help you and your child cope better with bedwetting:

• Make sure that your child has easy access to the toilet at night. For example, if they have a bunk bed they should sleep on the bottom. You could also leave a light on in the bathroom and put a child’s seat on the toilet.
• Use waterproof covers on your child’s mattress and duvet. After a bedwetting, use cold water or mild bleach to rinse your child’s bedding and nightclothes before washing them as usual.
• Avoid waking your child in the night or carrying them to the toilet, as these are unlikely to help them in the long-term.
• Following a bedwetting, older children may want to change their bedding at night to minimise disruption and embarrassment, so having clean bedding and nightclothes available for them can help.
• You can try taking off pull-ups at night, but this should be considered a trial rather than a treatment. If the child continues to wet, wearing pull-ups is often nicer for them and easier for the family to manage.