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INTRODUCTION

Soggy sheets and pajamas, a stained mattress and a bad-smelling room – and an embarrassed child – are familiar scenes in many homes.  But do not despair.  Bet-wetting, or nocturnal eneuresis, is not a sign of toilet training gone bad.  It’s often a normal part of development.

It is also know as nighttime incontinence.  Primary eneuresis is the term used to describe children who have never been dry at night.  Children who begin to wet the bed after at least six months of dry nights are said to have secondary eneuresis.

Generally, eneuresis 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, medication, or moisture alarms may help.

SIGNS AND SYMPTOMS

Simply, bed-wetting is characterized by involuntary urination at night.  Note the word �involuntary;’ the child is not doing it on purpose.

Most kids are toilet-trained between the ages 2 and 4 – but there’s no target date for developing complete bladder control.  At age 3, about 40 percent of children still wet the bed, and at age 5, about 20 percent still do, at least occasionally.

WHAT ARE THE CAUSES OF BED-WETTING?

No one knows for sure, but various factors play a role.

Inability to recognize a full bladder.  If the nerves that control the bladder are slow to mature, a full bladder may not rouse a child from sleep, especially if the child happens to be a deep sleeper.

A small bladder.  Your child’s bladder may not be developed enough to hold urine that’s produced during the night.  This is especially why it is important for kids who have the problem not to drink water or fluids too soon before bed.

Stress.  Stressful events such as starting a new school, sleeping away from home or getting a new brother or sister, may trigger bed-wetting.

A hormone imbalance.  During childhood, some kids don’t produce enough anti-diuretic hormone, ADH, to slow nighttime urine production.
Urinary tract infection.  An infection in the urinary tract (kidney to urethra) can make it difficult for your child to control urination.  Bed-wetting may be accompanied by frequent (daytime) urination and pain during the process.

Sleep apnea.  Sometimes a child’s breathing is interrupted during sleep, and bed-wetting can actually be a sign of this.  Apnea can result from enlarged or inflamed tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, and daytime drowsiness.  Teachers, look out for this at school.

Diabetes. For a child who is usually dry at night, eneuresis may be a sign of type1, or Juvenile onset (insulin-dependent) diabetes.  Other signs and symptoms may include unusual thirst, fatigue, and weight loss in spite of a good appetite.  Passing large amounts of urine at once is also a sign.  (These are the classic: polydipsia, polyphagia, and polyuria).

Chronic constipation.  Some kids who don’t pass stools regularly retain urine as well, leading to nocturnal eneuresis.

Anatomical defect.  On a rare occasion, bed-wetting is due to a defect in the child’s urinary system.

ANY RISK FACTORS?

Bed-wetting can affect anyone, but it’s twice as common in boys.  It also tends to run in the family.  A child with both parents who wet the bed has an 80 percent chance of wetting the bed, too.

WHEN TO SEE THE DOC

Most kids outgrow is problem on their own, but some need a little help.  In other cases, eneuresis may indicate an underlying condition that needs medical attention.

See the doc 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.

•    Bed-wetting is accompanied by painful urination, unusual thirst, pink urine, or snoring.

SCREENING AND DIAGNOSIS

Doc will ask questions (nothing new here) about the history of your child’s health and bed-wetting pattern.  For instance:

•    Is there a family history of bet-wetting?
•    Did your child always wet the bed, or did it begin recently?
•    How often does your child wet the bed?
•    Does the problem seem to be triggered by certain foods, drinks, or activities?
•    Is your child dry during the day?
•    Is the child undergoing any major life changes or other stresses?
•    Does the child experience pain or other symptoms when urinating?

Of course, doc will examine the child.  Urine tests may be done to check for any indication of infection or diabetes.  If an anatomical abnormality is suspected, X-Rays or other imaging study of the kidneys or bladder may be needed.

ANY COMPLICATIONS?

No health risks result from bed-wetting.  The guilt and embarrassment a child may feel about wetting may, however, lead to low self-esteem.

Rashes on the bottom and genital area may also be an issue, especially if your child sleeps in wet underwear.  To prevent a rash, help you child rinse these body areas every morning. Covering the affected area lightly with a petroleum ointment at bedtime may also help.

HOW IS BED-WETTING TREATED?

As we said before, most kids outgrow it on their own.  Limiting fluids before bedtime and double voiding – urinating at the start of the bedtime routine and then again just before falling asleep – may help.

Encourage your child to delay daytime urination as well.  If the bladder isn’t completely full, the urge to urinate may disappear within a few minutes.  With practice this simple “stretching exercise” may help your child’s bladder hold more urine at night.

If the child is still wetting by age 7 – and is motivated to stop – doctor may recommend more aggressive treatment.

Moisture alarms.

These battery-operated devices connect to a moisture-sensitive pad on your child’s pajamas or bedding.  When the pad senses wetness, the alarm goes off.

If you try this, give it a lot of time.  You may need two weeks to see any response and up to 12 weeks to enjoy dry nights.

Medication

This is used if all else fails.  Among the ones used are:
•    Desmopressin – This causes the body to make less urine at night.

•    Imipramine – This changes the child’s sleeping and waking pattern.  It also increases the amount of time a child can hold his urine, and also reduces the amount of urine produced.

•    Oxybutinin (Ditropan) – For a small bladder.  This reduces bladder contraction and increases the capacity.

Medication helps up to 70 percent of wetters.  No guarantees however, even when a combination of medications is used.  And wetting often resumes when medication is stopped.

ALTERNATIVE THERAPIES

Massage, acupuncture, and hypnosis have been said to be effective, but more research is needed to confirm this.

Drop me a note if you need some help in coping skills.

See you next week.

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