Bed Wetting Made Easy!

A boy becoming a man can be enough of a challenge to him and his family without the additional stress of a protracted bed wetting problem; older boys tend to be most often affected.

Girls are more likely to have both a day and night problem, which is a different story.

There are a range of causes of bladder dysfunction to be considered in any child who wets the bed, but when it appears that there are no other bowel, bladder, neurological or emotional causes, mono-symptomatic nocturnal enuresis, or bed wetting, as it is more commonly known, can occur in older boys.

There seems to be no solution for many, some of whom give up, resolving themselves to have a life-long problem.

But, there is almost always a solution, and often an “easy” one.

There are several reasonable steps that are can be taken, but they need to be part of a co-ordinated plan, including:

1. Drinking adequate volumes of fluid during the day – 2 litres per day.
2. Passing urine at least 5 times per day – “connecting” the brain and bladder.
3. Limiting the fluid intake later in the day, but consideration of
   a. How hot it is
   b. The level of exercise for the day
   c. The overall intake should be high
4. Passing urine before going to bed
5. Being woken to go to the toilet at the time the parents go to bed

More medical treatments that might be added are:

7. Using a wet-alarm

8. Medication, including:

a. Tofranil
b. Minirin

Most of these have been tried before a child is referred to a Paediatric Urologist, but often not with an overall strategy in mind. However, an almost instant cure often comes not from fiddling with the treatments listed above, but by focusing on developing a “can do” approach – if they play sort talk about which team wins the grand final, or which athlete wins the gold medal…the one who most wants to!

There are three other parts to what seems with some boys to be an almost a magic formula, which should all presented in a light-hearted, positive manner.

1.  Getting the boy to take responsibility, so that nagging for drinks before bed and not getting around to drinking during the day cease being a problem.

a.     “But I’m thirsty” equals “I want to wet the bed”
b.     “I can’t wake up” is the same as “I don’t care if I’m wet”
c.     They can have a late class of water, but only if they go and tip it in their bed.

2.     A consultation also involves exploring the body language of the young man, finding out what would make him want to get out of bed at 4am, without his parents waking him.  For the slightly younger boy it might be Christmas, for others it could be going on a fishing trip or a school camp. Once the right trigger is found, suggesting that the lad could be more excited by being dry, then considering….if he can wake up for “x”, he can wake up to stay dry.

3.     Bladder emptying dreams often occur as a memory of being half awake as they wet the bed, with the episode having been incorporated into a dream about swimming, running in the rain or something similar. Presenting the option, “well next time wake up and go to the toilet instead”, can often bring the response, “oh yeah”.

After a single discussion along the above lines, some boys never have a wet night, which can usually be predicted from the body language.

Article by Dr Paddy Dewan 23 May 2018