Bed-wetting, loss of urine during sleep, can be a major
problem for children. Bed-wetting is almost never done on
purpose or due to laziness on the child's part. The medical
term for bed-wetting is enuresis (en-your-ee-sis).
After toilet training, which usually occurs by four years of age,
many children have a brief period of wetting during the
daytime or at night. If bed-wetting is still occurring at age six
or seven, you should speak to your family doctor or
pediatrician.
In some cases, bed-wetting occurs with daytime wetting
and/or bowel problems. This may be a sign of a more serious
problem, and it is important to speak to your family doctor or
pediatrician. In some cases bed-wetting may be related to a
urinary infection, so every child should initially have his or her
urine tested by the doctor.
What causes bed-wetting?As children grow
older, they are usually able to stop wetting the bed at night.
However, many older children continue to wet the bed. There
is rarely one clear cause that can be determined. Several
factors seem to contribute to the problem including:• Arousal.
Some children do not wake up when their bladder is full.•
Some children produce more urine during sleep than do
others. • Some children have bladders that do not hold as
much urine as other children's do.• Genetics: There is a 15%
incidence of enuresis in children from families without the
problem compared to 44% and 77% of children when one or
both parents, respectively, were themselves enuretic.• Sleep
Apnea has been associated with enuresis.• Psychological
factors are clearly contributory in a minority of children with
enuresis. These children have experienced a stress such as
parental conflict, trauma, abuse, or hospitalization. In these
few cases the wetting is seen as a regressive symptoms in
response to the stress.
When will my child stop bed-wetting?Most
children outgrow bed-wetting. However, it is hard to say when
bed-wetting will stop. Every child is different. An estimated
five to seven million children in the United States wet their
beds. One out of five 5-year-olds are affected by this
condition. By age 10, only one in 20 have this problem. Some
children may be very upset by their problem and even have
feelings of personal failure. They may fear sleep-overs and
having friends find out about their bed-wetting.Are there
treatments for bed-wetting?Yes. Your doctor is
the best source of information. Doctors who care for children
have experience with bed-wetting. Treatments that may help
include the following:
1) Limiting fluid before bedtime - By itself, this rarely
works. Reasonable limitation of fluids, especially drinks that
have caffeine, such as colas, helps in a few cases.2) Waking
the child at set times during the night - Some families find
it helpful to wake the child once or twice at night to go to the
bathroom. This may help keep the bed dry but rarely helps a
child to stop bed-wetting.3) Special exercises to stretch or
condition the bladder - These are usually not successful.
These exercises are also generally unpleasant for the child and
family. These should never be used if your child wets during
the day or usually has to rush to go to the bathroom.4)
Moisture Alarms - These alarms often can condition the child
learn to feel when the bladder is full and when wetting is just
about to happen. The alarm consists of a moisture-sensing
device attached to the pajamas that wakes the child with a
loud signal or vibrating alarm. However, bed-wetters do not
always wake up to the alarms, which supports the idea that
many of these children have a problem waking up when their
bladders are full. As long as someone is sure the child wakes
up, the alarm may be successful. While it may take several
weeks or months for the child to stay dry on his or her own,
moisture alarms have the highest long-term success rate. The
success rate of moisture alarms increases significantly when
used with a well designed behavior modification program. A
psychologist with pediatric behavioral medicine expertise can
assist with developing such a program (e.g., Drs. Goldberg
and Lauretti). The alarm system we recommend is the Palco
Wet Stop.5) Medications - Several different types of
medications have been widely used to treat bed-wetting.
Medicines may have some side effects and are generally not
recommended before conditioning techniques such as the use
of moisture alarms with behavioral modification have been
used first without success. The few existing studies that
compare conditioning techniques with medications have shown
the conditioning to be significantly more effective. Speak to
your doctor about whether these medicines would be right for
your child. Your doctor may recommend a combination of
medications and other treatment methods. Not all children
respond to these medications.• Imipramine - Imipramine has
been used for many years to treat bed-wetting. Because this
medication is an anti-depressant, it can affect mood or
behavior in some patients. The medication is generally safe
when taken in the dose prescribed for bed-wetting. An
overdose may be dangerous, however, so parents should
carefully supervise a child who is taking the medication for
bed-wetting. The medication should be kept out of the reach of
younger children in the house. Studies have found that
conditioning techniques are significantly more effective than
Imipramine.• Desmopressin - This is a man-made form of the
hormone (antidiuretic hormone) that causes most people to
make less urine during sleep. This medication is called
desmopressin acetate and is available as a nasal spray or in
pill form. It works by decreasing the urine produced by the
kidney, resulting in less urine filling the bladder. Excessive
fluid intake should be avoided when taking this medication.•
Anticholinergics (Oxybutynin, Hyoscyamine) - These are
medications that relax the bladder and allow it to hold more
urine. They are often used to help children who also have
daytime wetting problems. Anticholinergics alone are usually
not effective for bed-wetting unless the child has daytime
wetting. In some cases, this medication may be used in
combination with desmopressin to control bed-wetting.
Common side effects of anticholinergics include dry mouth and
facial flushing.
6) Hypnotherapy - Limited studies have shown that
hypnotherapy helps some children. Further scientific study is
needed in this area.
7) Herbal, acupuncture and chiropractic therapies -
There is no scientific proof that these therapies work.
Common Questions Will my child
outgrow bed-wetting? Yes. What is not predictable is when
your child will outgrow the problem. Only one to two out of
100 bed-wetting children still have the problem by the time
they reach age 15. Although very rare, bed-wetting may
continue into adulthood.Does bed-wetting run in families?
Yes. If both parents were bed-wetters as children, then there
is a 7 out of 10 chance that their child will wet the bed. If one
parent was a bed-wetter, then there is a 4 out of 10
chance.Overview
Parents seeking an effective treatment for bedwetting, or
nocturnal enuresis, should understand that the illness is a
medical condition, not a behavioral one. Punishment does not
work and can even make the problem worse. While bedwetting
can happen at any age, doctors do not consider it a problem
unless the child is older than age 6. At that stage of
development, most children have the muscle function
necessary for bladder control. Only 1 percent of children still
have nocturnal enuresis as adults, according to the "American
Journal of Nursing.” Still, parents should work with a
pediatrician to rule out underlying illness or infection and
develop an effective treatment plan for bedwetting.
Treat Underlying Illness
The first step to finding a treatment for bedwetting is to
eliminate the possibility that an illness may be causing the
disorder. Bedwetting can be an early sign of diabetes. A
bladder infection, bowel disorder or simply maturational delay
may also be the culprit. Treating the underlying cause will
usually result in cessation of the bedwetting. If an underlying
illness is not discovered, a doctor may well suggest
management rather than treatment. Most children do grow out
of the condition. There is a strong genetic component to
bedwetting as well. A 2003 report in the journal “American
Family Physician” notes that the risk of a child having a
bedwetting problem is only 15 percent when both parents
have no history of bedwetting.
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Alarms
Bed alarms are easy to use, work well and are cost efficient.
They work best with children age 7 and older. Strong parental
commitment is required as well. When the child wets the bed,
the alarm sounds. In the beginning, a parent should wake the
child and guide him through the ritual of turning off the alarm,
going to the bathroom and then changing the sheets, bed
clothes and underwear. Most children experience success
within four months, according to “Developmental and
Behavioral Pediatrics."
Medication
There are two medications that physicians frequently prescribe
for nocturnal enuresis: imipramine and desmopressin acetate.
Desmopressin acetate is available as a nasal spray or as nose
drops. Imipramine is available as pills or capsules. Both
medications are effective, but not recommended for long-term
use. Also, both have high rates of relapse after a patient stops
taking the medication. For that reason, medication is often
used in conjunction with an alarm system.
Bladder Exercises
Some children who experience bedwetting simply have smaller
bladders than their peers. Bladder stretching exercises have
proven to be moderately effective. The technique involves
having a child regularly practice holding her urine for as long
as she can. A variation of this technique involves having a child
go to the bathroom when she has an urge to do so, holding her
urine for as long as possible and then starting and stopping the
flow of urine. In his book, “The Overactive Bladder: Evaluation
and Management,” Dr. Karl J. Kreder, director of urodynamics
and reconstructive urology at the University of Iowa, writes
that bladder training increases bladder capacity and improves
bladder control.
Double Bubble Technique
The double bubble technique places the responsibility for
management firmly into the child’s hands. A parent places a
plastic sheet over the mattress under the bed sheets. On top
of the bed sheets, another plastic sheet is positioned, followed
by another set of bed sheets. A clean set of bed clothes should
be placed near the bed. During the night, the child changes his
own sheets and clothing. This technique empowers the child
and also provides some relief to the primary care giver,
thereby diffusing family tension caused by chronic bedwetting.
