What sort of things might come up as causes?
Depending on where you start your enquiries, you might hear some of the following as possible reasons for prolonged bedwetting:
- Food allergy link: this has had some support and research, the theory being that allergies and even intolerances lead to an inflammatory state that may irritate cells that line organs, such as the bladder. To date there is no consensus. Dietary investigation into allergies is best done under the supervision of a qualified healthcare professional. If a food group is removed other options should be added to ensure a balanced diet is maintained so your child gets all the nutrients he or she needs to meet their growth and development. Medical testing often requires a referral from a doctor and wait lists can be long.
- Excessive sodium intake: this affects the passage of fluid through the kidneys and into the bladder and it has been suggested that it may upset body fluid levels. This may sound logical, but again there is no real scientific evidence to support this.
- Inflammatory processes: this being similar to the allergy theory, is offered on the basis that an intake of anti-inflammatory nutrients such as omega-3 fatty acids may reduce the symptoms of bedwetting. The theory is that omega-3s inhibit the production of substances that promote inflammation and that are thought to increase the levels of kidney (renal) oxide. Again, it is difficult to find a consensus of scientific studies that support this.
- Excessive body calcium levels: (which may be from diet or from ineffective body processing) leading to excessive calcium in the urine thought to cause an increase in urine flow. Recent studies, however, have refuted such findings.
- Being overweight: this has also been proposed as affecting kidney and bladder function and may play a role in bedwetting.
- Faulty central nervous system: signals controlling the bladder may not reach the bladder effectively.
Current views
Children’s bodies are still growing, all at different rates of course, and this includes actual organs. In some cases children bed wet because their bladder simply can’t hold the volume of water they require to process. Young children often require more fluid for their body size than older children and adults.
Some children have such deep sleep cycles that they simply don’t become aware that their brain is alerting them to a full bladder. Potentially a child’s waking mechanisms are not yet fully functioning.
Altered hormone production in the body is another area of investigation. Antidiuretic hormone (also called vasopressin) is made by the body when we need the kidneys to retain water, consequently the amount of urine that is made is also reduced. This is a hormone that helps to hold onto water in the body when we are dehydrated, for example. The influence of this hormone is being investigated as an issue in bedwetting.
Some children with very large urine production at night appear to have lower levels of antidiuretic hormone. There are a number of medications aimed at addressing this level, though it is interesting to note studies show that while medication can help reduce the symptoms and provide relief, the gains can diminish when the medication is stopped. Most studies support an integrated approach, combining strategies.
Constipation is also thought to be a factor and given how common it is in childhood (potentially due to increased fluid needs, reduced kidney functioning, inadequate fibre intake and possible functional issues in the bowel) it isn’t a big surprise. Large amounts of fecal matter around this area can potentially impinge on the bladder, reducing its fluid-holding capacity as well as possibly affecting the muscles in the area.
Action plan
There are many treatment options available ranging from diet, medication and alarms, though not all treatment options are relevant for all children. Nighttime bedwetting can be a cause of just one or a combination of factors and hence treatment/s will depend on the child.
There are a number of programs and also products to assist with reducing bedwetting. In many cases a detailed diary of fluids, foods and toilet habits is requested.
Check the bases first
Diet and Nutrition
Ensure your little one is having a varied and healthy diet full of fruit, veggies, wholegrains plus some meat/fish and dairy foods. Now this is, of course, easy to say but in many cases harder to do, especially if you have a fussy eater. As best you can, avoid foods with added sugar (or minimise it), ideally watch out for foods with additives, keep the home for healthy foods and leave the junk for parties.
Fluid
Don’t restrict fluids, research generally doesn’t support this, and the risk of dehydration is greater in children (especially young children). Fluid intake is very important as over the day all our body workings occur in a fluid medium. The Children’s Hospital Westmead also notes that fluid at night doesn’t appear to prevent or solve the problem. In some cases such as when a child is taking certain medications, fluid is restricted later at night.
Avoid caffeine-containing drinks such as cola or even chocolate, even more so avoid drinks with tannin such as teas.
Weight
While the research in this area still appears sketchy, maintaining a healthy body weight is in line with health guidelines. Of course the number of children in Australia and New Zealand who are either overweight or obese has risen alarmingly. Keeping children active and eating well is ideal for good health.
Words by Leanne Cooper from Sneakys Baby and Childhood nutrition. Visit www.sneakys.com.au. Copyright 2010.
This information is not intended to replace medical advice, if you are at all in doubt consult your general practitioner or other qualified health care professional without delay.