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Bedwetting - Helping Your Children Stay Dry

Does your child older than over the age of 6 have a problem wetting the bed every night? If the answer is yes, your child is one of the 6 million American children affected by a condition called enuresis, or bedwetting. In most cases this is a self-limiting problem that your child will out grow. For others, effective treatment is available.

Enuresis is considered a medical problem if the child has reached an age at which bedwetting should not happen, usually around 4-6 years of age.

During the first 2 to 3 years of life bed-wetting at night is normal and expected. 30% of children at the age of four years still wet the bed. 10% of children at the age of 5 to 6 years wet the bed and a little less than 5% still do so at the age of 10 years. 1% still wet the bed by the age of 18. Nocturnal enuresis occurs more commonly in boys than in girls.

Children vary in the age at which they are physically ready to have complete control over their bladders. This age tends to run in families, and so it is thought that children who bed-wet after the age of 6 years have bladder muscles that may not yet be strong enough to retain large amounts of urine. It is thought that enuresis may be inherited. Parents of these children often had similar problems controlling with enuresis.

Some children may have low levels of a hormone called antidiuretic hormone (ADH). This hormone helps the kidneys retain water, and with low levels, more urine is produced. Occasionally bed-wetting is associated with sleep terrors such as sleepwalking and nightmares. Of those children with night-time bed-wetting, only a tiny proportion, between 1-2%, have a physical disorder. Such disorders include:

urinary tract infections (the urinary tract consists of the kidneys, bladder and the tubes connecting them and leaving them, along which urine flows)
anatomical abnormalities of the urinary tract, such as narrowing of the urethra (the channel from the bladder through the penis, along which urine flows)
abnormal nerve control of the bladder
untreated diabetes (a very rare cause of enuresis).

Nocturnal enuresis can also have psychological causes. It is more common in children from families in which emotional difficulties are found. A psychologically stressful event such as the birth of a new sibling can often cause bed- wetting to start again after it has stopped.

What are the common symptoms and complications of nocturnal enuresis?

The only real complication of bed-wetting is often the embarrassment and humiliation felt by sufferers. Parents play a vital role in helping a child cope with this problem.

How do doctors recognize nocturnal enuresis?

Dr. Stephen Hales, a New Orleans pediatrician, reassures parents that continued bed-wetting after the age of 3 does not necessarily indicate a problem and he will usually suggest that parents simply "wait and see". This is sound advice, as bed-wetting usually stops on its own. Dr. Hales suggests that if a child is still bed-wetting at the age of six years, however, it is a good idea to see a pediatrician to rule out any physical causes of the bed-wetting. Tests on the blood and urine are carried out to look for infection or diabetes. The doctor will also inquire about any psychological or emotional problems that there might be at home or at school. For the vast majority of children, no obvious physical cause is found. This should be a relief to worried parents or affected children because the majority of these children will get better on their own.

What is the treatment for nocturnal enuresis?

If no physical cause is found and the child is less than six years old, Dr. Hales suggests that you simply monitor the situation, and that he or she will not need any specific treatment.

Whatever the child's age, however, a useful strategy is for the child to empty the bladder and avoid drinking fluids for a couple of hours before going to bed. Avoid drinks which contain caffeine (such as cola), which increases urine production. You could also try waking the child periodically throughout the night, but doctors believe that this does not help in the long term, since it trains the child to go to the toilet throughout the night. Encourage your child to take responsibility for the problems as much as he/ she is able, for example, by changing the wet bedding in the morning. Provide adequate night lighting so your child can reach the toilet easily. Your child needs your patience, support and encouragement. Never punish them as they are not bed-wetting on purpose. In fact, it is often effective to reward dry nights (increase the value of the rewards as the number of consecutive dry nights increase). If you suspect stress is the cause, encourage your child to talk about what's troubling him or her.

Bed-wetting alarms

Bed-wetting alarms are the most effective treatment currently available. The alarms are triggered by a few drops of urine and wake the child. They are cheap to install but take a few weeks before any effect is seen. At first the child wakes only after wetting the bed completely, but after a few weeks the child wets the bed less often and finally wakes in time to go to the toilet. About 70 per cent of children with night-time bed-wetting are cured using bed-wetting alarms and only about 10 per cent relapse when the treatment is stopped. After a period of about a month without bed-wetting, the alarm can usually be removed.

Medicines

Medicines are rarely prescribed because bed-wetting alarms are so effective. Two types of drugs can be given. Imipramine has the effect of relaxing the bladder and tightening the sphincter (preventing the passing of urine). Although it works quickly, most children start bed- wetting again when the drug is stopped. Another drug is called desmopressin. It is taken as a nasal spray or tablet and reduces the output of urine.

What is the outcome of nocturnal enuresis?

For the vast majority of children, night-time bed-wetting requires no treatment and goes away on its own, with time. It is extremely common and usually does not mean that there are any physical or psychological problems. Understanding and support for the child from parents is an essential part of treating this condition and helps to reassure the child that he or she should not feel guilty or anxious about their bed- wetting.

A pediatrician or family doctor should be consulted about the best treatment for your child. Effective treatment is available and you and your child can soon be singing, "how dry I am!"

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Reprinted with permission from Dialog Medical, dialogmedical.com.

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