With A/Prof Patrina Caldwell

Associate Professor Patrina Caldwell is a paediatrician who specialises in incontinence in children. She began working in childhood incontinence when she was researching recurrent (or reoccurring) urinary tract infections in children. “That research made me realise that a lot of children had problems with urinary incontinence and that was the beginning of a lifelong interest in this space.”

There are two main concerns when it comes to childhood urinary incontinence, bedwetting and daytime wetting. Bedwetting is the most common condition that parents seek help with. 

Bedwetting or nocturnal enuresis

Bedwetting, also known as nocturnal enuresis, may happen because a child is a very deep sleeper and they can't wake up to go to the toilet when their bladder is full. “People may think it's psychological or it's the bladder, but sleep is the biggest component of bedwetting.” Patrina explains.

There are other components that are involved in bedwetting, but deep sleep is the factor that is often present. Other components include

  • Can you wake up when your bladder is full?
  • How big is your bladder
  • How much urine do you make overnight? 

“If you are someone who has sleep problems and you cannot wake up when your bladder is full, then irrespective of the size of your bladder, or the amount of urine you make, you will wet when your bladder is too full” states Patrina.

There can also be a genetic tendency. If one or both parents were bedwetters, then their children have an increased likelihood of experiencing bedwetting. 

Treating bedwetting often involves treating the sleep difficulty. As each child is different, it is important to get an individual assessment from a health care professional. Common causes of deep sleep include not getting enough hours of sleep, finding it hard to fall asleep, disturbed sleep due to watching screens until too late at night and sleep disorders such as Obstructive Sleep Apnoea.

About one in two children who have Obstructive Sleep Apnoea will stop bedwetting when their sleep apnoea is treated, without anything else changing. There are other sleep conditions such as restless leg syndrome that can result in poor sleep and cause bedwetting.

Sometimes a child is just a very deep sleeper, who has perhaps become too practiced at holding on during the day. “If you are a child who is used to holding on when you need to go to the toilet during the day, then at night the little signal from your bladder to your brain to wake it up might not be recognised.”

Along with seeing a health care professional to address sleep difficulties, some of the other things you can do to help children with bedwetting are to make sure they are drinking adequate fluids and check that they are not constipated. Constipation in the lower bowel can affect the bladder.

Daytime wetting

Daytime wetting has quite a few possible causes. Children may have an underlying bladder condition such as a small bladder, so Patrina advises parents that it is important to see a health care professional to diagnose and treat these underlying causes.

Children are also in the middle of developing their mind-body connection. There are many elements to this connection that must work before a child can be independent. These elements include

  • Feeling the signal to go to the toilet
  • Recognising that the signal means that they need to go to the toilet
  • The ability to walk or physically get themselves to the toilet
  • The ability to undress themselves.

Patrina reflects that “there are a whole lot of things about feeling the signal and going to the toilet in that one small step. There are all sorts of psychological, behavioural and environmental factors involved in using the toilet.”

Holding on

Normally a child goes to the toilet about five to seven times a day. If they are only going two or three times a day, they are probably holding on and ignoring the cues to go.

Some children will avoid school toilets. Avoidance of school toilets can be a significant obstacle because children will hold on and not empty their bladder and they might avoid drinking fluids so they do not need to go. This can result in dehydration. “The Foundation has a program called Toilet Tactics, which addresses toileting issues at school. I encourage all parents, if their child has an issue with the toilets at school, to request that their school implements Toilet Tactics.”

Drinking enough fluid

It is important that children drink adequate fluids and do not avoid drinking. Children under the age of 12 should not be given drinks that contain caffeine, this includes many energy drinks, coffee and tea, as well as soft drinks such as coca cola.

Help is available 

“Your GP is the first place to go. It is important to get help because in a very small number of children, these problems can persist into adulthood” states Patrina. For some children, one visit can resolve the condition. When there are more complex causes it can take longer but it’s always worth addressing. “I want people to feel that they can get help because they most certainly can. If you’re told there’s nothing more you can do, well, usually that’s not true, there is more. A lot of GPs are now wanting to learn what else they can do besides the first line or initial treatment, which is really an excellent sign. If you need support and help call the Foundation’s National Continence Helpline on 1800 33 00 66 and they will help you work out the next steps.”

Information pull-outs:

Obstructive Sleep Apnea

Obstructive Sleep Apnoea is when your throat muscles relax too much while you are asleep and your airway is blocked or narrowed and your breathing is temporarily cut off. In children, this may be caused by adenoids or tonsils blocking the upper airway.

Restless Legs Syndrome

Restless Legs Syndrome is the urge to move your legs particularly when sitting or lying and especially at night and can be relieved by moving. Children with restless legs syndrome have an increased risk of experiencing bedwetting.

The National Continence Helpline

The National Continence Helpline 1800 33 00 66 is staffed by nurse continence specialists who offer free and confidential information, advice and support to people affected by incontinence. They also provide a wide range of continence resources and information on local continence services.

The helpline is available to anyone living in Australia and is funded by the Australian Government Department of Health. It operates 8am to 8pm (AEST) Monday to Friday excluding national public holidays. 

You can also book a call back at a time that suits you on our website.