Bedwetting

What is Bedwetting?
Bedwetting is a common pediatric concern affecting over five million children in the US. Medically it is called nocturnal enuresis, which refers to nighttime involuntary urination in children over the age of six. Most children achieve nighttime bladder control by age six years; however, about 6% of girls and 9% of boys continue to wet the bed at age 7. Many of these children gain nighttime bladder control by age 10 but some go on to experience bedwetting for several more years.

Children older than age 6 who have never achieved nighttime bladder control are said to have primary nocturnal enuresis. Your health care provider should be alerted to the presence of bedwetting to determine if there is a medical problem that needs to be addressed and assist the parent and child in choosing appropriate intervention strategies.

Some children achieve nighttime control by age 3 to 4 but then suddenly begin wetting the bed again. These children are said to have secondary enuresis. There are many causes of secondary enuresis including psycho-social factors, physical factors, diabetes, child abuse, or change in sleep patterns. Secondary enuresis should be quickly brought to the attention of the child’s health care provider.

What Causes Bedwetting?
There are a variety of factors that cause or contribute to bedwetting. They include:

  • Genetics (bedwetting tends to run in families)
  • Gender (bedwetting is more common in boys than girls)
  • Sleep or arousal disturbances
  • Small bladder (the child’s bladder may not be developed enough)
  • Inability to recognize the feeling of a full bladder (developmental)
  • Hormonal factors (too little of the hormone antidiuretic hormone which slows nighttime urine production)
  • Stress (first exposure to school, new baby brother, parental divorce, etc.)
  • Urinary tract infections
  • Abnormality of the spine or nervous system (infrequent)

How can your child’s nurse practitioner or physician help?
The primary care provider will ask you and your child several questions about factors that may be related to bedwetting such as a family history of enuresis, current and past bladder control, sleep patterns, physical and social symptoms, and family situational factors. These questions will help the provider determine if and how much more how much investigation needs to be completed. A physical examination will help to determine if a physical abnormality is present or if there are other factors that need attention. A urinalysis will be probably be obtained to assess for infection and diabetes. Referral to a urologist or other specialist is infrequently needed.

When is Bedwetting a Problem?
Parents and children may answer this question differently. For parents, caring for wet children and wet sheets, often several days a week and in the middle of the night, can be frustrating. Bedwetting is not so much a problem as an inconvenience. Children are sometimes not bothered by bedwetting unless they feel pressure or teasing from parents, siblings, or friends. Children often voice concerns about bedwetting at the age when it may affect sleepovers with friends, visiting grandparents, or attendance at summer camp. Older children know that most of their friends do not have bedwetting problems and self-esteem can be affected. Keeping an open an honest line of communication with your child is the first and best way to protect their emotional health. Be sensitive and be discreet. No child should have to hear a discussion about his/her bedwetting at a social event such as a family gathering. If you deal with the issue in a matter of fact way, your child will likely do the same.

What are the Treatments
The treatments for bedwetting depend considerably on the cause and the level of concern of both the child and the parent. The most common approaches are behavioral, environmental, and medical interventions. These interventions are not cures but may be helpful in decreasing nighttime wetting. They may be used singularly or in combination. Medications are not without possible side effects to be sure to discuss them thoroughly with your child’s health care provider.

Behavioral

Interventions

Environmental Interventions

Medical Interventions

Limit fluid intake after six PM
Place night lights in the hallway and bathroom to make it easier, less scary, and safe to go to the bathroom at night.
Medication to decrease the amount of urine the bladder makes.
Take the child to the bathroom just before going to sleep and again before parents retire
Keep a clear pathway from the child’s bed to the bathroom
Medication that helps the bladder hold more urine and decreases bladder contractions
Use a bedwetting alarm
Protect the bed by using a plastic mattress cover-this makes cleanup much easier and helps to eliminate smell
Medication that changes a child’s sleeping patterns

Create a reward system for nights the child can stay dry
Have an extra set of clean PJ’s easily available

 Explain to your child that bedwetting tends to run in families and let them know about your family history

 
 Assist your child in gaining a sense of control by having him/her place the wet sheets in the washing machine

 
 
What Doesn’t Work
Bedwetting is not your child’s fault. Punishment, yelling, or scolding is never helpful and may create considerably more problems such as embarrassment, guilt and shame. Staying calm, acting with a mater of fact attitude, reassuring your child bedwetting is a common problem, and helping your child understand that he/she will likely outgrow the problem is beneficial.

A Word About Bedwetting Alarms
Bedwetting alarms can be very effective but alarms take time to be effective. Parents and children need to understand that they are not magic and training may take weeks to months. The most common type of alarm senses moisture. A battery operated devise is connected to a pad on the child’s bed and sounds when the child starts to urinate. Unfortunately, some children are heavy sleepers and sleep right through the sound of the alarm. In this case, parents hear the alarm and then wake the child helping them to become sensitive to the sound. There are several Internet sites that provide alarms. One such site is: www.bedwettingsotore.com

Summary
Bedwetting is a common pediatric problem. The best outcomes occur when parents, children, and health care providers work together in finding solutions.