Bedwetting

Bedwetting Basics

Bedwetting or nocturnal enuresis is a common and frustrating problem for kids and their parents. Part of the problem is that many families have unrealistic expectations for when kids should stay dry at night.

Unfortunately, simply mastering potty training during the day does not mean that your child will stay dry at night. In fact, while most kids become potty trained by the time they are 3 to 4 years old, about 15% of kids wet the bed when they are 5 years old, and 7 to 10% of 7 year olds and 3% of 10 year olds are bedwetters. After that, about 15% of bedwetters outgrow wetting the bed each year so that by the age of 15, only about 1% of teens still wet the bed.

Bedwetting Facts

Although most parents blame their child's bedwetting on the fact that their child is a deep sleeper, bedwetting is actually a very complex problem with multiple medical, physiologic, behavioral, and environmental causes.

Genetics plays a very important role in bedwetting, with most studies showing that if one or both parents were bedwetters, then there is a very good chance that their children will wet the bed too.

Keep in mind that there is no good, single explanation for why most kids wet the bed.

Diagnosis of Bedwetting

Testing is rarely necessary for children with primary nocturnal enuresis, who have never been dry at night. You should talk to your Pediatrician if your child was previously dry at night for at least six months and then began wetting the bed again, which is called secondary nocturnal enuresis, or if your child also has accidents during the day.

Initial testing, when needed, usually includes a urinalysis and urine culture. More detailed testing might include a renal ultrasound, voiding cystourethrogram, and/or uroflowmetry.

Coping With Bedwetting

Most importantly, reassure your child that bedwetting isn't his fault and never punish your child for wetting the bed. A visit to your doctor, even if you aren't interest in treating your child's bedwetting, can be helpful to reassure your child that this is a normal part of development and that there is a good chance that he will eventually outgrow it.

Although younger kids can wear pull-ups, for older bedwetters, it can be helpful to use waterproof mattress pads and overlays, zippered vinyl mattress covers, and/or a waterproof mattress overlay that you can put over your child's sheets.

It can also help to have your older child help change the bed and clean the bedding, although this shouldn't be viewed as a punishment.

Bedwetting Treatments

Since about 15% of bedwetters are spontaneously cured each year without any treatment at all, one treatment option is to simply do nothing and just wait for your child to outgrow his bedwetting. If your child is over 6 or 7 years old and his bedwetting is beginning to bother him, especially if it is limiting him from going on campouts or sleepovers, doing nothing may not be a good option though, and you might consider these behavioral and/or medical treatments:

Behavioral Treatments for Bedwetting

Behavioral treatments are usually tried first when treating a child with bedwetting. This includes the obvious recommendations of not drinking a lot of fluids right before bed, making sure your child urinates before going to bed, and avoiding caffeine, which can act as a diuretic.

Other behavioral treatments for bedwetting can include:

• waking your child to urinate during the night. Parents use different methods to do this, including waking their child when they go to bed, waking the child just before he usually wets the bed, or taking their child to the bathroom without fully waking him up (lifting).


• practicing bladder stretching exercises. This is also called retention control training and involves giving your child a lot of fluids to drink and then asking him to hold his urine for a short time when he needs to urinate to see if he can learn to increase the amount of urine his bladder can hold. Keep in mind that it is controversial as to whether or not this practice actually works.


• using a bedwetting alarm (enuresis alarm). These are probably the most helpful treatment for bedwetting and include an alarm and a moisture sensor that attaches to your child's underwear or sheets. When your child begins to wet the bed, the sensor triggers the bedwetting alarm, which either wakes up your child or a parent, who can then wake up the child. Problems with bedwetting alarms include that they can take several months to work, they don't work for everyone, some children have relapses after they stop using the alarm, and the nightly alarms, which sometimes go off several times a night and can wake up everyone in the house, can be stressful for some families.


• hypnosis and acupuncture are sometimes offered as alternative treatments for children with bedwetting.

Medical Treatments for Bedwetting

After the age of 6, if behavioral treatments aren't working and bedwetting is bothering your child, affecting his self-esteem, or limiting his activities, then you might consider medical treatments, including:

• DDAVP or Desmopressin, which works to decrease urine production in the kidneys. DDAVP is a tablet or nose spray that is taken about 1 hour before bedtime on the nights that your child wants to stay dry, such as during a sleepover or campout, although some children take it every night. Since DDAVP causes fluid retention, it is important that your child not drink a lot of fluids after taking it at night. It is important to note that DDAVP is not a cure for bedwetting and your child is likely to start bedwetting again once he stops taking it, although there is always the 15% chance that your child will outgrow his bedwetting each year while he is taking it.


• imipramine is a tricyclic antidepressant that is used to treat bedwetting, although like DDAVP, relapses are common once your child stops taking it.


• oxybutynin is another medication that is sometimes used to treat bedwetting, either alone or with imipramine, especially if your child has other symptoms or problems.

What You Need To Know

• The medical term for bedwetting is nocturnal enuresis.
• Bedwetting is more common in boys.
• About 5 to 7 million children in the United States wet the bed.
• A child has a 77% chance of being a bedwetter if both his parents were bedwetters, a 43% chance if only one parents wet the bed, and only a 15% chance if neither parent suffered from bedwetting as a child.
• Although 15% of children naturally outgrow their bedwetting each year, treatments are available, so be sure to talk to your Pediatrician if your child is still wetting the bed once he is 6 or 7 years old.
• A Pediatric Urologist or Pediatric Nephrologist can be helpful in treating children with bedwetting.

References:

1Nocturnal enuresis: medical management. Mammen AA - Urol Clin North Am - 01-AUG-2004; 31(3): 491-8, ix
2Nocturnal enuresis: behavioral treatments. Blum NJ - Urol Clin North Am - 01-AUG-2004; 31(3): 499-507, ix
3Behrman: Nelson Textbook of Pediatrics, 17th ed., Copyright © 2004 Saunders, An Imprint of Elsevier
4Walsh: Campbell's Urology, 8th ed., Copyright © 2002 Saunders, An Imprint of Elsevier