Nocturnal Enuresis

This leaflet explains nocturnal enuresis, also known as bedwetting, in children during sleep. There are two types of nocturnal enuresis, primary nocturnal enuresis and secondary nocturnal enuresis.

What is Primary Nocturnal Enuresis?

Primary nocturnal enuresis is the involuntary passage of urine during sleep by a child aged 5 years or older, who has never achieved consistent night-time dryness.

This can be broken down to:

• Primary nocturnal enuresis without daytime wetting: children who have wetting only at night.

• Primary nocturnal enuresis with some daytime symptoms: those who also have daytime symptoms such as urgency, frequency or even daytime wetting.

What is Secondary Nocturnal Enuresis?

Secondary nocturnal enuresis is the involuntary passage of urine during sleep by a child who has previously been dry for at least six months in a row.

Important facts you should know

• Bedwetting is not your child’s fault and your child should never be punished, as this can humiliate them and reduce their self-esteem.

• Bedwetting occurs because the volume of urine produced at night is too much for the bladder to hold and the sensation of the full bladder does not wake the child up.

• Almost all children (99%) become dry given time. Sometimes this could be in their late teens. This can happen even without treatment usually because they:
  • Develop an increased bladder capacity and/or
  • Produce less urine at night and/or
  • Learn to wake to the sensation of a full bladder.

Three models of enuresis

Deep Sleep – Does your child wake to external noise or weather? Does your child wake after bedwetting?

Lack of Vasopressin (a hormone) – If you do not have enough vasopressin, your kidneys may work too hard overnight and produce too much urine.

Overactive Bladder – Bladder instability, over activity, low functioning bladder capacity.

Recommended fluid intake

Bedwetting advice

Dry nights are more likely to happen if you:

• Try not to have caffeinated drinks, tea, coffee, hot chocolate, cocoa, fizzy drinks or blackcurrant juice as these can irritate your bladder and make you feel that you want to pass urine more often.
• Try to drink about 6 to 8 large cups of fluid (200 to 250mls) regularly throughout the day, not all at once after school.
• Avoid putting off and holding on to urine. Go to the toilet when you get the feeling to go, do not wait but don’t go back and forth every few minutes either.
• Go to the toilet while you are at school. Go at every break, morning, lunch and afternoon. At home, go to the toilet at least every 2 to 3 hours.
• Try not to get constipation as this can make you less able to hold as much urine as you should in your bladder and make you pass urine more often during the day. It can make you dribble urine and cause damp patches in your pants which can make you sore.
• Prevent urine infections by making sure your bladder is fully emptied every time you have a wee. Sit comfortably, relax and count to ten and try and have another wee.
• Try sitting on the toilet with your feet flat on the ground or on a stool. Do not hold onto the toilet seat and make sure your feet do not dangle.
• Wipe front to back after you have been to the toilet if you are a girl.
• Try sitting down on the toilet instead of standing to wee every time, especially before going to bed if you are a boy.
• Have your last drink 1 hour and 30 minutes before bedtime so when you go to bed you can empty your bladder fully.
• Have a wee on your way to bed before your bedtime. When you are about to go to sleep, get up and go to the toilet again.
• When you go to bed tell yourself as you fall to sleep, “I will wake up if I need a wee, I will wake up if I need a wee…”

What can I do as a parent/carer to support dry nights?

• Do not lift a child at night on your way to bed or set an alarm to wake them to go to the toilet. This is encouraging them to wee at that time even if they are sleeping.
• Do encourage the child to toilet if they wake up.
• Make sure your child can get to the toilet easily, maybe leave a night light on or get them a torch.
• Try not to use disposable nappies or pull-ups as they may slow progress. The nurse can direct you to mattress/pillow protectors.
• Do not go back to using pull-ups/nappies once you have decided not to use them.
• Ensure bed clothing is easy to take off and put on, often just pants and a t-shirt or nightie is best.
• Do not allow your child to jump into bed with you. It is easier, but certainly does not discourage the bedwetting.
• Leave dry bedding and clothes close by so that you and/or your child can change their clothing and the bedding easily with minimal disturbance.
• Support your child if they need help but try not to do everything for them. Encourage them to take ownership of the problem.
• Never make your child feel as if the bedwetting is their fault. It is not.
• Reward your child with praise and/or choice of activities for them to do for simply participating in behaviours which will help to stop bedwetting, even if it is not always successful straight away.
• The reward does not have to cost anything, in fact spending extra quality time with your child doing something you both enjoy is most beneficial.
• Encourage your child to keep a positive attitude. Remind them that the last thing to think before going to sleep is, “I am going to stay dry tonight.”
• Do not expect an immediate overnight success, although it can happen, it usually takes a while.

Contact numbers

North Tees and Hartlepool NHS Foundation Trust

Children’s Services Hub

Children’s Continence Team

Telephone: 01429 522417

Monday to Friday, 9.00am to 5.00pm

References

National Institute for Health and Care Excellence (2010) Bedwetting in Under 19s Clinical Guideline [CG111]. Available at: https://www.nice.org.uk/guidance/cg111

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