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For Your Child

 

Many Older Children Struggle With Bedwetting 

But treatments can correct the problem, experts say

If you have been washing your child's urine-stained bed sheets every morning for far too many years, do not punish him—he may have a condition called nocturnal enuresis.
That is the medical term for bedwetting, a common problem that affects an estimated 5 million to 7 million older children in the United States.Picture of a young boy sitting in a field of wild flowers

Children generally stop wetting the bed by age 3, says Dr. Marc Cendron, a professor of surgery (urology) and pediatrics at Children's Hospital at Dartmouth in Lebanon, N.H.

Though kids may have the occasional "accident" up to about age 5, children who are still wetting the bed on a regular basis after that probably have nocturnal enuresis. The problem, which is more common in boys than in girls and can run in families, can sometimes persist throughout the teen years.

Bedwetting Is Treatable

What many parents do not realize is that bedwetting is treatable, Cendron says. Unaware that something can be done about it, many parents do not think of raising the issue with their child's physician. And pediatricians may not routinely ask whether bedwetting is an issue with the child, Cendron adds.

They should. Nocturnal enuresis is very common in older children. About 20 percent of 5 year olds wet the bed, according to the American Academy of Pediatrics, as do about 10 percent of 6-year-olds and 3 percent of 12-year-olds.

"What I find almost outrageous is there are treatments out there and kids can get help and support and they're not offered by doctors," Cendron says. "There are a lot of kids out there who have this problem, and it's not addressed as well as it should be."

Factors That Contribute to Bedwetting in Children

Two factors can contribute to bedwetting in children. The first is underdeveloped internal signals to wake the child when he or she needs to urinate.

"Bedwetters are in a situation where the bladder is not communicating with the brain," Cendron explains. "The bladder empties spontaneously without the brain knowing it."

One method of developing these internal signals is by having the child wear pajamas or underwear that have a moisture sensor, which sets off an alarm when the child starts to urinate.

Because most children with nocturnal enuresis are deep sleepers, there is a good chance the child will sleep right through the alarm—but the rest of the family will wake up.

Even if the parents have to then wake the child and take him to the bathroom, repeating the process night after night can help the child learn to wake himself, Cendron says.

A second option is medication.

One type decreases the amount of urine produced at night. Children who wet the bed tend to have low levels of a hormone called antidiuretic hormone, which regulates urine production by the kidneys, Cendron says.

The hormone helps the kidneys retain water, thereby reducing the amount of urine filling the bladder. Low levels of the hormone means a child tends to produce a lot of urine at night.

A medication called DDAVP can reduce the amount of urine the kidneys produce at night. It may also help a child wake more easily at night, Cendron says.

Another option is imipramine, an anti-depressant that can have a similar effect. But imipramine can cause nausea, insomnia, and dry mouth. In high dosages, imipramine can also cause irregular heartbeats and even death, Cendron says. For those reasons, he rarely prescribes it.

What is certain is that punishing or berating the child is never the solution, says Dr. Edward Goldson, a professor in the department of pediatrics at the University of Colorado Health Sciences Center.

"It simply doesn't help, and it can be counterproductive," Goldson says. "By blowing it up and embarrassing the child, you will not accomplish what you want, which is nighttime dryness."

Parents can understandably get extremely frustrated by a child who wets the bed, mistakenly believing the child is "acting out" and wetting on purpose, Goldson says.

Making matters worse, siblings can tease. And the child can be too embarrassed to go to sleepovers or to camp. Wetting the bed can also damage the child's self-esteem, especially if parents blame him.

"As the child gets older, it can be a huge psycho-social stressor," Cendron says. "It can cause some real psychological difficulties."

Wetting the bed runs in families. If both parents wet the bed when they were kid, their child has a 70 percent chance of being a bed wetter, according to the National Kidney Foundation.

The good news is about 15 percent of children who wet the bed stop wetting spontaneously with each successive birthday, Cendron says.

Only about .01 percent of adults still wet the bed, he says.

The best thing for parents to do is reassure the child that he will stop wetting the bed in time and, if it persists, to get treatment.

One final note: It is important to differentiate between what is known as "primary" nocturnal enuresis from "secondary" nocturnal enuresis. "Primary" means the child never had control of his bladder at night.

With primary nocturnal enuresis, less than 1percent of the cases are caused by some underlying medical problem, such as diabetes or kidney or bladder infections, according to the American Academy of Pediatrics.

But if a child has control of his bladder and then starts wetting the bed later in life—a condition called "secondary" nocturnal enuresis—you should take the child to a pediatrician for a check-up, Goldson says.

While it is usually nothing serious, it could in some cases mean a bladder infection or some emotional trauma that is causing the problem, he adds.

Always consult your child's physician for more information.


Online Resources

(MUSC Children's Hospital is not responsible for the content of Internet sites.)

American Academy of Pediatrics (AAP)

National Kidney Foundation

Proceedings of the National Academy of Sciences

December 2002

Bedwetting Is Treatable

Factors That Contribute to Bedwetting in Children

What Is Urinary Incontinence (Enuresis)?

What Causes Urinary Incontinence?

How Is Urinary Incontinence (Enuresis) Diagnosed?

Treatment For Urinary Incontinence (Enuresis)

Online Resources 


What Is Urinary Incontinence (Enuresis)?

Urinary incontinence (enuresis) is a medical name for bedwetting, or the accidental urination in children who should be developmentally able to have control of their bladders. Girls usually have bladder control before boys do. The diagnosis of enuresis is for girls over the age of 5 and for boys over the age of 6 that are still having urinary control problems. There are different types of bedwetting that may occur, including the following:

  • diurnal enuresis - wetting during the day.

  • nocturnal enuresis - wetting during the night.

  • primary enuresis - occurs when the child has never fully mastered toilet-training.

  • secondary enuresis - occurs when the child did have a period of dryness, but then returned to having periods of incontinence.

What Causes Urinary Incontinence?

There are many factors that may be involved, and many theories that are given for why children wet the bed. The following is a list of some of the possible reasons for the problem:

  • poor toilet-training

  • delay of the ability to hold urine (this may be a factor up to about the age of 5)

  • small bladders

  • poor sleep habits or the presence of a sleep disorder

  • a problem with the proper functioning of hormones that help to regulate urination

How Is Urinary Incontinence (Enuresis) Diagnosed?

Urinary incontinence (enuresis) is usually diagnosed based on a complete medical history and physical examination of your child. In addition to talking with you and the child, your child's physician may perform the following to help rule out other causes for the wetting:

  • urine tests (to make sure there is not an underlying infection, or condition such as diabetes)

  • blood pressure measurement

  • blood tests


Treatment For Urinary Incontinence (Enuresis)

Specific treatment for enuresis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history

  • extent of the condition

  • your child's tolerance for specific medications, procedures, or therapies

  • expectations for the course of the condition
    your opinion or preference

Prior to starting treatment, it is important to know that:

  • The child is not at fault and should not be punished. The child cannot control the wetting.

  • Enuresis is very common among 5-year-olds.

Treatment may include:

  • positive reinforcement of the child (i.e., the use of sticker charts for dry nights)

  • use of night-time alarms to help tell the child when wetting is occurring

  • medications, as prescribed by your child's physician (to help control the wetting)

  • bladder training to help increase the bladder size and the child's ability to know when they have to urinate (this is done by having the child wait as long as possible during the day to urinate and let the bladder get full)

In addition, counseling of the child and family may help to determine any stress the child may be under. Strategies for reducing your child's stress will be discussed. Always consult your child's physician for more information.





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