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Problem Overview
"Oh no, not again!" Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often a normal part of development.
Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Children who've never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.
Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, nighttime bladder control simply may not be established. If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.
Signs and symptoms
Bed-wetting is characterized by involuntary urination at night. Most kids are fully toilet trained between ages 2 and 4 — but there's no target date for developing complete bladder control. At age 3, about 40 percent of children wet the bed. At age 5, bed-wetting remains a problem for up to 20 percent of children.
Causes
No one knows for sure what causes bed-wetting, but various factors may play a role.
A small bladder - Your child's bladder may not be developed enough to hold urine produced during the night.
Inability to recognize a full bladder - If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep — especially if your child is a deep sleeper.
A hormone imbalance - During childhood, some kids don't produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production.
Stress or Stressful events — such as becoming a big brother or sister, starting a new school or sleeping away from home — may trigger bed-wetting.
Urinary tract infection - A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, frequent urination and pain during urination.
Sleep apnea - Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness.
Diabetes - For a child who's usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, unusual thirst, and fatigue and weight loss in spite of a good appetite.
Chronic constipation - Sometimes children who don't have regular bowel movements retain urine as well. This can lead to bed-wetting at night.
Anatomical defect - Rarely, bed-wetting is related to a defect in the child's urinary system.
Risk factors
Bed-wetting can affect anyone, but it's twice as common in boys. It also tends to run in families. A child with two parents who wet the bed as children has an 80 percent chance of wetting the bed, too.
When to seek medical advice
Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may indicate an underlying condition that needs medical attention.
Consult your child's doctor if:
- Your child still wets the bed after age 5 or 6
- Your child starts to wet the bed after a period of being dry at night
- The bed-wetting is accompanied by painful urination, unusual thirst, pink urine or snoring
Screening and diagnosis
The doctor may begin by asking questions about your child's health history and bed-wetting pattern. For example:
- Is there a family history of bed-wetting?
- Has your child always wet the bed, or did it begin recently?
- How often does your child wet the bed?
- Does the bed-wetting seem to be triggered by certain foods, drinks or activities?
- Is your child dry during the day?
- Is your child facing any major life changes or other stresses?
- Does your child complain of pain or other symptoms when urinating?
Next, your child will need a physical exam. Depending on the circumstances, urine tests may be done to check for signs of an infection or diabetes. If the doctor suspects an anatomical abnormality or other problem, your child may need X-rays or other imaging studies of the kidneys or bladder.
Complications
Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.
Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.
Treatment
Most children outgrow bed-wetting on their own. Limiting fluids before bedtime and double voiding — urinating at the beginning of the bedtime routine and then again just before falling asleep — may help.
You may want to encourage your child to delay daytime urination as well. If the bladder isn't completely full, the urge to urinate may fade within a few minutes. With practice, this simple "stretching exercise" may help your child's bladder hold more urine at night. If your child is still wetting the bed by age 7 — and is motivated to stop — your child's doctor may recommend more aggressive treatment.
Moisture alarms
These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — hopefully in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.
If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights.
Medication
If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:
Slow nighttime urine production - The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone that forces the body to make less urine at night. The medication is available as a pill or nasal spray. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids.
Change a child's sleeping and waking pattern - The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has few side effects for bed-wetters. Caution is essential, however. An overdose could be fatal.
Calm the bladder - If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsinex) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.
Medication may help up to 70 percent of bed-wetters stay dry at night. Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped.
Alternative therapies
Therapies such as massage, acupuncture and hypnosis have been touted as helpful treatments for bed-wetting. More research is needed before such therapies can be proved effective, however.
Coping skills
Children don't wet the bed to irritate their parents. Be patient as you and your child work through the problem together.
Adopt good habits - Limit your child's fluid intake during the evening. Make sure your child urinates before going to bed — and perhaps again when you turn in for the night. Remind your child that it's OK to use the toilet during the night if needed.
Be sensitive to your child's feelings - If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past.
Put your child to bed earlier - Perhaps surprisingly, an extra 30 minutes of sleep a night helps some children stop wetting the bed.
Plan for easy cleanup - Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy.
Enlist your child's help - Perhaps your child can rinse his or her wet underwear and pajamas, or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
Celebrate effort - Don't punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents. With reassurance, support and understanding, your child can look forward to the dry nights ahead.
Courtesy article provided by www.mayoclinic.com
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