Cover image
WATERTIGHT
A guide for older children,
young people and parents
about bed-wetting

“Watertight” aims to give older children and their parents, useful advice and information about the urinary system and explains how a common problem like bed-wetting occurs and what can be done about it.

“Watertight” is one of three booklets about childhood enuresis (bed-wetting) originally produced by the Continence Foundation of Australia.

Sleepover (a story for children), Dry Night (a guide for parents) and Watertight (a guide for older children and adolescents) was made possible under funding to the National Continence Helpline by the Australian Government. The Helpline is a government project managed by the Continence Foundation under the National Continence Management Strategy (now the National Continence Program).

The National Continence Helpline (1800 330 066) assists parents, grandparents, family, carers and children with advice and information about incontinence, good bladder and bowel habits, products and services and offers a range of free leaflets on many aspects of incontinence.

For further information on the web about incontinence, you can visit the following websites:
National Continence Program: www.bladderbowel.gov.au
Continence Foundation of Australia: www.continence.org.au

Contents

Foreword

A message from the Continence Foundation

Watertight is a resource for parents and older children and is one of three booklets about childhood enuresis (bed-wetting). It gives useful advice and information about the urinary system, explains how a common problem like bed-wetting occurs and what can be done about it.

Watertight touches on many of the issues associated with bed-wetting: Embarrassment, frustration and isolation, but also commitment, support, trust and achievement. It is one of a set of three very popular resources (Sleepover, Dry Night and Watertight). Their reprint was made possible under the Australian Government’s National Continence Management Strategy, recognising that good bladder and bowel habits should be encouraged from early age, that bed-wetting often runs in families and that these problems may have implications later in life.

The Continence Foundation of Australia seeks to encourage good bladder and bowel habits in children by offering current information and encouraging parents to contact a health professional who is skilled in continence care.

Research has given a greater understanding of the likely causes of bed-wetting. Working with a general practitioner, paediatrician, continence nurse advisor or physiotherapist specialising in this area of health is therefore highly recommended for children wanting to be ‘dry’.

Barry Cahill signature
Barry Cahill
Chief Executive Officer
Continence Foundation of Australia
(2005)

Support from specialist continence clinics and medical specialists throughout the treatment phase can be the key to your success. You can phone the National Continence Helpline (FREECALLTM 1800 330 066) for information about where you can get help.

A new start

For those of you who have picked up this book because of a problem with staying dry at night, there are a few things to be said.

Firstly, it is fairly common to find entirely normal, healthy, intelligent and above all, mature teenagers who still wet the bed at night. How can you wet the bed and be normal, healthy and mature? Well, here are the facts: Firstly, when the experts have studied bed-wetting they find there are thousands of people, including adults, who lose control of their bladder at night while they’re asleep.

Secondly, by the time a person has reached his or her teenage years with a bed-wetting problem, he or she will probably have tried most forms of treatment known and they won’t have worked. That means by now such people are sometimes not feeling good about themselves and are thinking that nothing can be done and “what’s the use?”

The big picture

This book explains that something can be done, although maybe it’s a treatment that has been tried before and perhaps the time just wasn’t right back then.

You’re not alone!

In the first year of secondary school there will be one person in every class of 30 students and at the age of 15 there may be one in every two classes.

Nationwide, that’s a lot of people who aren’t abnormal in any way! They’ve just been unlucky enough to have this problem. Some families don’t talk about it much. But the chances are very high that other adults somewhere in your family were also bed-wetters when they were young.

People who wet the bed have often been told that they’re deep sleepers, but other people who are deep sleepers don’t wet the bed—it’s a matter of “learning” to wake up. So it is still possible to help deep sleepers with their bed-wetting.

Bed-wetting is common

There are thousands of people, including adults, who lose control of their bladder at night, while they’re asleep. The reason is that their messaging system from bladder to brain and back again is not fully mature. There’s nothing else wrong with them. They’re just as mature personality-wise as anyone else.

In a school class of 30:

Teenagers who still wet the bed often believe they’re the only ones. But that’s not true—far from it! There are millions of teenagers world-wide who are in the same position.

But that doesn’t mean bed-wetting is easy to cope with or talk about. Some people even hide it from their brothers and sisters because they don’t want them telling their mates.

It’s common to feel very embarrassed and some feel quite depressed and hopeless about it all. The idea of camps or sleeping over at friends seems impossible, and you might be worried if you’re starting to have intimate relationships.

Some teenagers worry that because they wet the bed there might be something abnormal with them sexually. In fact, although you can understand why someone might think like that, they’re worrying unnecessarily because there is no link at all between bed-wetting and sexual development or sexual activity.

The other thing is that by the time you’re in your teens, your parents may have tried many treatments to help you become dry at night and so you wonder what, if anything, can be done, or will you be like this forever?

Well, the answer is that the vast majority of people can be helped, even if previous treatment has been unsuccessful. In recent years, new approaches to treatment are more successful.

It will be much quicker and easier to overcome the problem if you confide in a health professional who is experienced in helping teenagers like yourself. This person can act as a “coach” for you while you are overcoming bed-wetting.

But it relies on the person with the problem wanting to fix it up.

No-one can make you do it.

What's what—and where


Production of urine

The brain:

  • should tell the kidneys to slow urine production at night, by sending a chemical message from a tiny gland called the pituitary
  • is told by the bladder when it’s full
  • should be able to tell the bladder when to empty itself

The kidneys:

  • clean the blood
  • adjust the amount of water and salt in the blood
  • get rid of all sorts of substances into the urine which the body doesn’t need

The bladder:

  • stores the urine which comes down from the kidneys
  • is like a bag that is wrapped in a layer of muscle
  • will empty automatically if the brain doesn’t send the right messages telling the bladder what to do

Kidneys

There are two kidneys. If you put your hands on your sides just below the ribs, your kidneys sit between your thumb and forefinger. The kidneys are small—less than the size of a fist—and their main job is to clean up the blood and make sure the body contains the right amount of water and salt.

The kidneys produce your urine. They’re like a tap that’s never turned off (unless you’re very ill.)

They’re on the go 24 hours a day, although at night they usually make a little less urine. The chemical message which tells the kidneys to slow down at night comes from the brain and the correct messages allow most people to get a good night’s sleep without having to go to the toilet.

There are some people of all ages—children, teenagers and adults—whose brains, for some unknown reason, don’t send enough of this chemical message. There’s nothing else wrong with them. What then happens in some of them is that the bladder fills up just as quickly when they’re sleeping as when they’re awake during the day.

Bed-wetting can occur in some people if the bladder isn’t too good at sending signals back to the brain, when it is full. The bladder can then empty early and they wet the bed.

Ureters

The ureters are two narrow tubes that carry the urine from your kidneys to your bladder.

Bladder

The bladder lies just behind the bone you can feel at the bottom of your abdomen (called the pubic bone).

When the bladder’s full, it rises above the bone and can sometimes be felt if you’re lying flat. The bladder is basically somewhere to store your urine until enough has collected to make it worth your while going to the toilet.

But it’s a mistake to think of the bladder as just a balloon or bag—because it’s far more than that. The bladder has a mind of its own. During the day, you can “tell” it what to do. In other words, you can go to the toilet and pass urine when you want to—but some people have bladder trouble when they’re asleep.

It’s perhaps stretching the point to say the bladder has a mind of its own, but it does send signals to the brain when it’s full. The bladder is surrounded by a layer of muscle that can squeeze either automatically or on instruction from the brain, emptying out the urine inside it.

As young children, you learn to recognise those signals and stop the bladder muscles contracting until you’re ready to go to the toilet. That’s easiest during the day when you’re wide awake, so you learn that first. Learning to be dry at night means you have to learn to do two things: “Hold on” all night, or wake up to go to the toilet when the bladder feels full.

If the waking mechanisms in your brain aren’t fully developed, you just don’t wake up when the bladder calls in “Full”. Add to that the possibility that your kidneys may not be slowing down their urine production at night, then there’s a lot of urine for the bladder to store. When the bladder is not able to hold on any longer it simply has a good squeeze. The result is a wet bed.

Urethra

The urethra is the tube that carries urine from the bladder to outside the body. In girls, the urethra is short, while in boys it’s longer and passes down the centre of the penis.

Now that you realise that you’re not alone with this problem— and you know a bit more about how the body’s urinary system works—you might be feeling that you can do something about your problem.

Production of urine
Kidneys
Production of urine
Ureters
Production of urine
Bladder
Production of urine
Urethra

And you can! But...

If you’re seriously into doing something about wetting the bed, then read on, because what we’ve got here for you is a six-step guide to dealing with it and becoming “watertight”...

THE SIX-STEP GUIDE

STEP 1 Acknowledge what's NOT causing the problem

Losing bladder control at night is NOT caused by:

STEP 2 Understanding the process of bed-wetting

When you are asleep, the brain isn’t responding to the signal from the bladder that it wants to be emptied. Think of the brain as being like a computer working while you’re asleep—you’re not aware of it but someone should have programmed the computer to either wake you up to go to the toilet if you need to go, or else ‘hold on’ until the morning.

Bed-wetting is HARDLY EVER caused by:

Things that may make bed-wetting worse:

The doctor can do some simple tests to rule out any unusual medical conditions—but...

If you notice a burning sensation or pain when you pass urine, you should tell the doctor. You could have a urinary tract infection and this requires treatment.

If you start feeling thirsty all the time, plus passing urine more frequently, it is very important that you tell the doctor (and your parents) and be checked for diabetes.

A note about fluids:

It is very important that you are very aware of what sort of fluids make up your daily intake, as well as that you drink a sufficient amount.

As a GENERAL rule—as an adolescent or adult—you should be drinking ABOUT 6–8 glasses of fluid a day, but you should certainly drink whenever you feel thirsty and also try to spread your fluid intake fairly evenly over the day. Water is best.

Remember that if you increase your fibre, you will need to increase your fluid intake.

STEP 3 Stop doing things that don't do any good

These are now known by bed-wetting experts to be a waste of time:

STEP 4 Start doing things that will help

These tips will help to get you on the road to dryness:

Drink plenty of fluid every day: It’s really important. Think of it as a bit like sports training. You’ve got to get the muscles around your bladder toned up and your bladder used to the idea of accepting lots of urine before messaging the brain that it’s full and wanting to empty itself.

So, drink lots (but avoid drinks containing caffeine and alcohol)—water is best.

Training for better bladder control: During the day, when you feel as though your bladder is full and you need to go to the toilet, try holding on for a few minutes rather than going straight away. If you find that you can hold on for five minutes without a problem then try waiting a bit longer each time. But don’t wait so long that it’s really uncomfortable—just push yourself gently. This bladder training will gradually teach your bladder to hold more urine.

Remake the bed yourself: Now this isn’t “Be Kind To Parents Week!” It’s also not punishment. It’s part of the training discipline. Just as top swimmers have to get up early for training and horse riders have to do their own grooming, when you remake your own bed, it’s just part of ‘getting into it’ more. It’s boring, but it’s part of the deal.

Keep a Diary: You won’t know whether anything’s improving unless you keep a diary or record of what’s going on.

But it shouldn’t just be about wet or dry nights: The columns in your diary ought to allow you to record how often the bed may have been wet during the night, the size of the wet patch, who made the bed, and so on.

For some people who really flood the bed, it might be hard to say just how wet the bed was. In that situation it might make more sense to simply note the wet or dry nights.

Here’s a sample of what it could look like, but you should make one up that suits you best. If you are clever on a computer, you could even set up a spreadsheet to do this if you wanted to.

PROGRESS DIARY

If wet
DATEDRYTIME/SIZEWAKE UP?CHANGED BED?COMMENTS
10/9yesLate to bed
11/9no3:30am
Big
yesyes—meHad lots of fizzy big drinks yesterday afternoon.

STEP 5 Using an alarm program

Alarm programs work for most people who have trouble with their bladder control at night. You may have tried an alarm before, but now that you’re older and with the help of an expert in treating bed-wetting, it’s worth having another really good go.

The alarm is a way of getting through to the brain that it should listen when the bladder sends a message that it’s full. It’s a form of training. There are different types of alarms you can choose from. It is important that you choose the type that suits you—that you think will wake you and be best for you.

With the body-worn alarm, the alarm itself is pinned on your T-shirt or pyjama top near your shoulder and the sensor is placed between two pairs of underpants or in a pad inside the underpants.

The bedside alarm involves sleeping on a mat which is placed under the sheet you lie on and is connected to an alarm box placed at the foot of the bed.

The most common reason why alarm programs don’t work is that the alarm isn’t in use consistently. Some people don’t reset the alarm after it has gone off during the night. The usual reason is that everyone’s so tired that they can’t bear the thought of it going off again. That’s really understandable but it is really important to reset the alarm. It’s got to be on for the whole night and be able to go off every single time you wet the bed. Otherwise it won’t have much, if any, effect.

Here are some important things to know about the alarm:

Make your life as easy as possible! The National Continence Helpline advisors or your continence coach can tell you about products such as pads or mattress covers that can make your life much easier when coping with a bed-wetting problem.

STEP SIX Find out about medications

If you’ve got this far and nothing has worked, then there are medicines which can help the majority of people to have more dry nights, that come in the form of a nose spray.

The sprays can be used alone or in combination with the alarm—be guided by your doctor. Follow your doctor’s instructions carefully about how to use this medication.

These medications help your kidneys to ease up on making urine. It doesn’t work in everyone, and it’s not a substitute for the alarm.

Sometimes medications can lessen unstable bladder contractions and thereby increase your bladder’s ability to hold more urine.

A note about bladder training

There is an occasional person who has what’s called an unstable bladder, where during the day he may have feelings of urgency to pass urine and needs to rush to the toilet.

This may be helped by bladder training where you gradually teach your bladder to accept more urine. Sometimes medication can help this condition. A doctor will be able to determine if this is appropriate for you and will supervise a bladder training program.

Medication is usually prescribed in conjunction with the training program for better bladder control. It may also be used with an alarm program.

A final message and further help

A final message

We hope that teenagers reading this guide will feel reassured that they will be able to overcome bed-wetting and that there are people who can help them.

Motivation and consistency and commitment are keys to success.

Remember

For further help

The National Continence Helpline (FREECALLTM 1800 330 066) can advise on an incontinence problem, give you the details of a clinic or continence advisor nearby, as well as provide information about helpful products available.

The Helpline is a confidential national telephone service. Continence consultants can give you information about poor bladder control across all age groups—from childhood bed-wetting, in adolescents, young mothers, menopause— or prostate-related, in association with other health conditions such as diabetes, stroke or MS, or surgery-related, etc, through to aged care.

The Helpline is a free service managed by the Continence Foundation of Australia under the Australian Government’s National Continence Management Strategy.

For further help contact

The National Continence Helpline (FREECALLTM 1800 330 066) can give you the details of a clinic or continence advisor nearby, as well as advice on helpful products available.

Continence Foundation of Australia (CFA) Resource Centres:

CFA in New South Wales
T 02 8741 5699
E contfoundnsw@ozemail.com.au

CFA Victoria (Victorian Continence Resource Centre)
T 03 9816 8266
E cfavic@continencevictoria.org.au

CFA in WA
T 08 9386 9777
E info@continencewa.org.au

Acknowledgements

The set of 3 Childhood Enuresis Booklets—Sleepover, The Dry Night, and Watertight—were originally produced in 1996 under the guidance of the Childhood Continence Working Party, a national, multi-disciplinary group drawn from appropriate academic, professional and community organisations.

The Continence Foundation of Australia is grateful to these people for their contribution, particularly those who contributed their efforts on an honorary basis in addition to usual work commitments:

Ms Janet ChasePhysiotherapist
Ms Rowan CockerellContinence Nurse Advisor
Ms Chris HarkessContinence Nurse Advisor
Ms Susan HouldsworthConsumer Representative
Dr Martin KnappPhysician and Nephrologist
Ms Susan McCarthyContinence Nurse Advisor
Assoc Prof Richard MillardUrologist
Assoc Prof Terry NolanPaediatrician
Dr Jan PatersonContinence Nurse Advisor
Dr Norman SwanAuthor of the original set of three booklets

Call the National Continence Helpline on FREECALLTM 1800 330 066 *

The Helpline has a team of clinical advisors providing free and confidential information, leaflets and referrals to local services.

For more information, you can also visit:

* Calls from mobile telephones are charged at applicable rates.



Watertight

ISBN: 1–74186–642–1
Online ISBN: 1–74186–643–X
Publications Approval Number: P3–3926


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This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to the Department of Health and Ageing.


A project of the National Continence Management Strategy, an Australian Government Initiative.

Developed by the Continence Foundation of Australia,
AMA House, 293 Royal Parade, Parkville, VIC, 3052,
Phone 03 9347 2522