Bedwetting is involuntary urinationin children over 5 to 6 years old. It may occur at ay time of the day or night.
Causes, Incidence, and Risk Factors
Children develop complete control over their bladders at different ages. Nighttime dryness is usually the last stage of toilet learning. When children wet the bed more that twice per month after age 5 or 6, it is call bedwetting or nocturnal enuresis.
Bed wetting it common, more than 5 million children in the U.S. wet the bed at night. Some children still wet the bed at age 7. The numbers drop slightly by age 10. Although the problem goes away over time, many children and even a small number of adults continue to have bed wetting episodes.
Bedwetting runs in families, There are two types of bed wetting.
- Primary enuresis: children never been constantly dry at night. This usually occurs when the body makes more urine overnight than the bladder can hold and the child does not wake up when the bladder is full. The child’s brain has not learned to respond to the signal that the bladder is full. It is not the childs or parents fault.
- Secondary enuresis: Children who were dry for atleast 6 months start bedwetting again. There are may reasons that children wet the bed after being fully toilet trained. It might be physical, emotional, or just a change in sleep.
Physical causes are rare, but may include lower spinal cord lesions, birth defects of the genitourinary tract, infections of the urinary tract, or diabetes.
Signs & Tests
Dr. Eisner will discuss the history of bedwetting in detail. You can help by keeping a detailed diary that outlines normal urination and wetting episodes, fluid and food intake (including time of meals), and sleep times.
Doing nothing or punishing the child are both common responses to bedwetting. Neither helps. You should reassure your child that bedwetting is common and can be helped.
Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep. You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids excessively.
Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. While this is unlikely to solve the problem completely, it can help and should be tried before medicines are used. It is most useful in younger children, about 5 to 8 years old.
Bedwetting alarms are another method that can be used along with reward systems. The alarms are small and readily available without a prescription at many stores.
The alarm wakes the child or parent when the child starts to urinate, so the child can get up and use the bathroom. Alarm training can take several months to work properly. You may need to train your child more than once. Bedwetting alarms have a high success rate if used consistently.
Once your child is dry for 3 weeks, continue using the alarm for another 2 weeks and then stop.
A prescription medication called DDAVP (desmopressin) is available to treat bedwetting. It will decrease the amount of urine produced at night. DDAVP is easy to use and provides quick results. It can be used short-term for an important sleepover, or prescribed for long-term use for months. Your doctor may recommend stopping the medicine at different times to see if the bedwetting has gone away.
Tricyclic antidepressants (most often imipramine) can also help with bedwetting. However, side effects can be bothersome, and an overdose can be life-threatening. Therefore, these drugs are usually used when other treatments have failed.
Some sources find that bedwetting alarms combined with medicine results in the highest number of cures.
For children with the secondary enuresis, your doctor will look for the cause of the bedwetting before recommending treatment.