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Bedwetting
Question:
Hi, I'm hoping you can help me please. We took our now 8yr old out of night time pull ups 2 and 1/2 years ago at which stage his pull ups were wet every morning. After a couple of months of 3-4 wet beds a week he was doing pretty well and we only had 1-2 wet beds a week. To start with we lifted him every night before we went to bed but stopped this after about a year. Last year he went about 6 months without bed wetting then we moved to New Zealand, from the UK, in September and he started wetting the bed several nights a week again. We started lifting him again and gradually this got better but he was still wetting the bed frequently. In March we moved house and his wetting increased again so we started lifting again. We went away for a week on 21st April and he wet the bed frequently while we were away. This last week my husband has been going to bed latter (due to work) and so has lifted him later and he's already wet the bed by 11pm and then again by the morning. 2 wet beds a night. My approach has always been to go with and try to stay relaxed about it, as I know he can do it as he went 6 months of being dry but 2 wet beds a night is a big backward step and our son is starting to say that he's really disappointed in himself for wetting - we always tell him its okay and not to worry about it. He's at an age now where he's starting to go to sleepovers at friends(which being new to the country / area / school we're encouraging) but we're having to get him to wear pull ups - which he understandably hates. I appreciate that we've gone through a lot of change in the last 10 months - which outwardly he's coped with remarkably well but I am now concerned at how much he's wetting the bed. Any advice would be very much appreciated. Many thanks.
Answer(s):
Hi,
You have been very intuitive in realising that all the moves and changes over the last year have contributed to your sons bedwetting. It can be that the change in routine has also had an impact on his drinking and toileting habits, which in turn can lead to a smaller bladder capacity. This could be why he wets more than once per night. Anxiety can also increase frequency of voiding, again leading to the bladder capacity to reduce. Another reason why children may wet more than once per night is low levels of vasopressin. This is the hormone that stops our bodies producing so much urine at night and needing to empty the bladder. It would seem though that as he has been dry in the past, the hormone is working.
It would be a useful exercise for you to put him in a pull up or night nappy for a couple of nights, and weigh it to see how much urine he is producing overnight. 1gm = 1ml. Also, get him to measure his voided urine during the day. He should do this when he feels the urge to void, but not when he has been holding on for long. I would expect him to be passing around 240 � 270ml at each void. If he is not voiding these volumes, get him to do some bladder retraining. This involves having a full glass or cup of fluid two hourly, and toileting two hourly. He should be consuming around 1.8 litres of fluid per day. It is important the fluid is spaced out during the day so that the bladder has a chance to fill and empty, thus strengthening the bladder muscle and allowing it to hold more. Once he has started bladder retraining, get him to measure his urine weekly so that he can see that the measures are increasing. The first week he commences the training he is likely to be wetter as his body adjusts to the extra fluids, but after that he will start wetting less.
If he has a problem delaying the urge to void and is toileting frequently, you may wish to ask his GP about an anticholinergic medication such as Oxybutynin while he is doing bladder retraining. This will help him delay the urge to void longer. Once his voided volumes are within the expected range, this medication can be weaned.Â
I hope this is helpful to you.
