Self help measures to improve symptoms
Fluid intake
The bowel and bladder are closely related. A good fluid intake is vital for a healthy bladder. Below is the recommended fluid intake for each age group.
This is the amount that we need your child to be drinking. We only count water based fluids, milk and smoothies not included in the amount but your child can have this in addition. They need to drink the majority of this fluid before 5pm. Please encourage them by using reward charts and making it fun such as measuring the amount each day so that they know how much they need to drink. Fluid charts are enclosed for you to record the amount your child drinks.
4-8 years- girls and boys, 1000-1400mls per day
9-13 years- girls 1200-2100 mls per day, boys 1400-2100mls per day
14-18 years- girl’s 1400-2500mls per day, boys 2100mls- 3200mls per day
Ref: NICE (2010) Nocturnal enuresis: The management of bedwetting in children and young people.
Try to encourage your child to have some large drinks to help increase their bladder capacity. You may find it useful to complete the enclosed fluid charts to chart the progress with this. This is the expected bladder capacity for age-
Age 5= 180mls Age 6= 210mls Age 7= 240mls
Age 8= 270mls Age 9= 300mls Age 10= 330mls
Age 11= 360mls Age 12= 390mls
Try excluding bladder irritants, these are blackcurrant juice, pure orange juice, caffeine drinks and fizzy drinks. We would suggest cutting all of these out and reintroducing slowly, keeping a diary to see if these have any effect on the wetting.
Fibre and exercise
Encourage your child to have a varied diet with good fibre intake. If you would like to know more about the fibre content of food please refer to understanding childhood constipation by bladder and bowel UK- https://www.bbuk.org.uk/wp-content/uploads/2017/11/Understanding-childhood-constipation-leaflet-advice-for-parents-and-carers.pdf
It is important for your child to be active encourage the NHS offers these guidelines https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-children-and-young-people/
Toileting and sitting position
Encourage your child to go to the toilet regularly throughout the day (every 2-3 hours) to pass urine and encourage them to sit on the toilet twenty minutes after meals. They need to sit on the toilet for about 5-10 minutes, encourage them to relax and push the poo out.
It is important that they are in a good position whilst sat on the toilet, use a stool so that their feet are flat on the floor. They need to feel safe while sat on the toilet. The best position is for their knees to be bent and be higher than their hips.
Stay with them while they are on the toilet and get them to concentrate on what they are doing. Blowing bubbles/ windmills/ blowing apps can help also getting them to move while they are sat will help them relax and increase the chance of them opening their bowels. Keep a record of when your child is opening their bowel enclosed is the ERIC poo diary.
Constipation
If your child is experiencing constipation, it is helpful to look at ERIC and bowel and bladder UK websites for information about constipation.
We don’t always know why constipation occurs- reasons can include putting off going to the toilet, poor fluid intake and not sitting on the toilet for long enough. Sometimes soiling can happen, this is because the bowel is full of poo and over time the amount of poo gets bigger and harder stretching the bowel. The large bits of poo wedge open the bottom which allows the liquid poo to escape.
If your child has been prescribed medication it is important that this is taken as directed. Have a look at the medication packet and information sheet it will tell you how much water is needed to mix the sachet. It is very important that you follow this and add the water accurately for it to work effectively. Once the powder is dissolved in water the solution can be added to anything or cordial can be added. Further information is available from ERIC and bowel and bladder UK, the links are below-
https://www.bbuk.org.uk/wp-content/uploads/2018/05/Macrogols.pdf
https://www.eric.org.uk/pdf-how-to-prepare-macrogol-laxatives
Many parents worry that the laxatives make the soiling problem worse, but it’s important that the blockage is fully cleared. Stopping the medication too soon can result in the constipation recurring. After this, a smaller, daily maintenance dose of laxatives will be required. The aim of the maintenance dose is to prevent poos from building up again. If the maintenance dose isn’t followed and the stretched rectum is not allowed to gradually return to its normal size, your child might become constipated again. Laxative treatment may need to be taken for several months and shouldn’t be stopped abruptly. Some children might need it for several years and a minority will require long-term laxative treatment.
You may find a book a useful tool for talking to your child
Daytime wetting
If your child is experiencing daytime wetting, this may be occurring due to constipation, their bladder not being big enough, their bladder sending a signal to the brain to empty before it’s full and being too distracted when bladder is sending signal to go to the toilet. Most children have reliable bladder control by the age of 5 but for every 30 children 1 to 2 will suffer from daytime wetting (Promocon, 2016).
Encourage your child to go to the toilet regularly throughout the day we suggest starting at every one and a half hours. There are a wide range of watches available such as: WobL watch and TabTime. If they are able to stay dry the length of time between toilet visits can be increased.
For boys encourage them to sit on the toilet to pass urine this will slow them down and will help them relax to completely empty. For both boys and girls use a stool so that their feet are flat on the floor get them to slow down and concentrate on fully emptying their bladder. When they have finished ask them to rock forwards and backwards and to sit for a further two minutes. When cleaning encourage girls to wipe from front to back when cleaning their bottom to minimise risk of infection.
Encourage your child to quickly change their clothing if they have wet, remaining in the wet clothes increases the risk of infection. To help them be more independent have a bag with everything that they need in it, let them know where they need to put the wet clothing. If your child is self-conscious about this but needs support cleaning themselves use a secret sign a small object that they can pass over which both of you will know indicates that they have wet.
If using reward charts always ask them to do something that is within their control. Your child is unable to control if they are wet but they are able to manage the amount that they drink, going to the toilet regularly and telling someone when they have wet.
Night time wetting
If your child is experiencing night time wetting, encourage them to go to the toilet while they are getting ready for bed and again just before they go to sleep. Please encourage boys to sit on the toilet to help them fully empty their bladder.
If currently in continence products try them out of these. Use mattress protection such as a Kylie sheet. Discuss with your child and arrange a plan of how you will manage this and what they need to do. Have clean pyjama’s and bedding ready for them each night, involve them with the cleaning up process and ask them to help such as taking the wet bedding and clothing to the washing machine each morning. Put a torch by your child’s bed or leave a light on if your child is scared of the dark.
If using reward charts always ask them to do something that is within their control. Your child is unable to control if they are wet but they are able to manage the amount they are drinking each day and help with the cleaning up process.
Consider the use of an enuresis alarm as a service we are unable to provide these but there is a wide variety that can be purchased online. We would suggest looking at the ERIC website as they have a leaflet available to download – bedwetting alarms- Your questions answered they also have a diary for your child to use to mark the progress.
Bedwetting is a widespread and distressing condition. There are half a million children and young people in the UK that suffer from night time wetting. Your child is not on their own around 1 in 15 seven year olds and 1 in 75 teenagers suffer from the condition.
Appointment from the Children’s Bladder and Bowel Nursing Team
Even if you have tried these measures previously we would suggest retrying these.
Please note we are only able to offer a clinic appointment after we have received the completed fluid charts and poo diary which we have included.
If you would like these to be reviewed and further advice given please could you return via email to springboard.admin@ncic.nhs.uk
We will be unable to move onto pharmaceutical interventions until we have seen your child, completed our assessment and the self-help measures are in place. If we feel that laxatives are needed we will suggest that you arrange a consultation with your child’s GP.
There are support groups that you can access
ERIC- www.eric.org.uk
Helpline- 0845 370 8008
Bowel and bladder UK- www.bbuk.org.uk
Helpline- 0161 607 8219
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Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302