|
As almost all parents know, bedwetting is very common. But what you may not realize is that in almost all cases there are simple steps you can take to deal with it. Between 5 million to 7 million children in the United States wet their beds on a given night. The condition is much more common in boys. But remember, no child purposefully wets the bed. Punishing or teasing a child who wets the bed makes the problem worse. Most children outgrow bedwetting. But if the problem causes the child or the family a great deal of stress, many different approaches can be taken.
Bedwetting has nothing to do with the way a child has been potty trained. How a child has been taught to use the toilet does not determine if a child will have a problem with bedwetting. You have not done anything wrong and you are not to blame for a child wetting their bed.
Types of bedwetting
The medical term for bedwetting is enuresis pronounced en-yur-ee-sis. If you want to search medical texts for information on bedwetting, you will find it is divided into three main types:
- Diurnal enuresis (day wetting)
- Primary nocturnal enuresis (nighttime wetting, never dry)
- Secondary nocturnal enuresis (nighttime wetting, once dry)
How common is bedwetting?
While this problem can be frustrating, keep in mind it is very common. At least one episode of bedwetting per month is found in about 10 percent to 20 percent of all 5-year-old children in the United States. The problem occurs in about 5 percent to 7 percent of all 10-year-old children. The problem occurs in only 2 percent to 4 percent of children ages 12 to 14. Bedwetting occurs in about 1 percent of adults.
What is causing the problem?
There is considerable debate about the true causes of bedwetting. In some cases, the child might have a small bladder or that the child is a very deep sleeper and the urge to urinate simply doesn't wake the child. However, pediatricians say children with normal bladders and normal sleep patterns can also have a problem with bedwetting.
The problem does tend to run in families. Studies suggest that if both parents have a history of bedwetting, then their child will have a 77 percent chance of wetting the bed. If only one parent wet the bed, a child has a 44 percent chance of wetting the bed. There is about a 15 percent chance that a child will wet the bed if neither parent has had a history of bedwetting.
A hormonal reason may be to blame. Some research shows a child may have insufficient nighttime quantities of a hormone called antidiuretic hormone (ADH). Generally, ADH levels rise at night and reduce urine production during sleep. However, in some children, there is inadequate nighttime ADH production, and so the child produces more urine. One approach to treating bedwetting involves increasing ADH.
Bedwetting treatments
- Some pediatricians recommend bladder control exercises to help stretch and condition a child's bladder. These exercises can include learning to not urinate immediately when the urge occurs and learning to stop urine flow midstream to strengthen bladder muscles.
- It can help to limit food and beverages after dinnertime and to limit fluids that contain caffeine, such as colas and teas late at night.
- Bedwetting alarm devices are highly effective. These devices attach to pajamas or underpants and are activated by moisture. They usually involve a sensor that triggers an alarm that wakes the child when he or she starts to urinate. This approach will require a supportive and helpful family and may mean the parents also get up at night. Your physician can recommend moisture alarms.
- Desmopressin acetate is known as DDAVP. This is a drug that comes in pill form as well as a nasal spray. Desmopressin acetate is a synthetic form of an antidiuretic hormone. Research suggests that DDAVP reduces urine production in children ages 6 and older who wet the bed by supplementing their natural level of antidiuretic hormone.
- Ditropan® (oxybutynin) and Detrol® (tolterodine) are two medications that have been found to help some bed wetters. Both medications are approved by the Food and Drug Administration for treating an overactive bladder. However, some pediatricians say they can be effective for bedwetting. Both are in tablet form.
- Imipramine, a tricyclic antidepressant, is also in tablet form. This compound's mechanism of action is unknown, but its effect on the urinary system is thought to be separate from its antidepressant effect. With this medication, the success rates are between 30 percent and 50 percent. However, many children continue bedwetting once the medication is stopped. This medication can cause side effects. So, it must be used with care and close supervision of your physician.
- Hypnosis is another approach to combating bedwetting. This approach is reportedly is being used successfully by those trained in this therapy. The National Enuresis Society says medical studies show hypnotherapy can work quickly within four to six sessions. It can be less expensive, less time-consuming and less dangerous than most approaches because it has virtually no side effects.
Combination therapies may have higher success rates
Some specialists in this area say combination therapies may work best for some children. When using an alarm device, it usually takes about four to six weeks to see significant results. However, with imipramine, the effects are usually seen within a matter of days. Combining these two approaches may achieve quick and more long-lasting results for some children.
Will an alarm device harm a child's self-esteem?
Alarm devices are seen by some pediatricians as the most effective approach. Studies have shown alarm devices can have a 60 percent to 85 percent success rate with less than a 35 percent relapse rate once the alarm is discontinued. However, a significant number of pediatricians say these devices are hard on children and become a form of discipline. Doctors believe the devices become a form of punishment and are degrading and humiliating to the child. Often times, it is best to discuss these issues with your healthcare provider.
The biggest misconception about bedwetting
Research shows the biggest misconception parents have about bedwetting is that it is a form of rebellious behavior. This is never the case. Wetting the bed is never because of anger or spitefulness.
Avoiding embarrassment
There are many steps you can take to help a child who may feel a loss of self-esteem with bedwetting. If you used to wet the bed as a child, be sure to explain that to your child. If a child understands that bedwetting is hereditary, it will help ease anxiety and help your child better understand that this is a very common problem and not the child's fault.
Never punish your child for wetting the bed
All pediatricians agree that you should never punish or belittle your child for wetting the bed. This will only add to a child's embarrassment. Instead, offer rewards for dry nights and take as many opportunities as possible to offer encouraging words. Also, provide positive reinforcement and offer words of praise and even rewards when a child has been compliant with the treatment method chosen. This may be difficult, especially if the child did not have a dry night. Allowing a child to be teased or ridiculed only contributes to the problem and makes the situation worse.
Establish a "no teasing" rule
Many experts in this area say it is a good idea to set up a "no teasing" rule in your family. This means not allowing anyone in the household, especially siblings, to tease a child who wets the bed. Explain to them that their brother or sister does not want to wet the bed on purpose and teasing will hurt not help. It is also a good idea not to make an issue of the bedwetting every single time it occurs.
Positive steps you can take to help your child
Talking to your child about the problem in a private setting can be beneficial. A child may feel embarrassed around their siblings or other adults. Studies show many children hide their problem and think that something is wrong with them. It may surprise some parents, but physicians say that if a child understands they suffer from a medical problem, then they understand they are not to blame. Changing a child's habits after dinner can make a significant difference. You may want to limit all beverages after 6 p.m. to just very small amounts. Avoid food and drinks containing caffeine, which is a diuretic. It may also be helpful to avoid any beverages that are carbonated, as well as citrus juices. Always encourage your child to urinate before going to bed.
Getting the child involved
Until your child overcomes this problem, put a rubber or plastic cover between the sheet and the mattress. This protects the bed from getting wet and smelling of urine. The American Academy of Pediatrics (AAP) says encourage your child to change the wet sheets and covers. This may help teach responsibility. At the same time, it can help relieve your child of any embarrassment from having family members know every time he or she wets the bed. However, the AAP says if others in the family do not have similar chores, then the child may see this as punishment. In that case, it is not recommended.
What parents can expect
Bedwetting does not pose a threat to your child's health. Discuss your child's bedwetting history with your health care provider and rule out a physical problem such as diabetes or a urinary tract infection. If your physician thinks there may be a medical problem that needs to be treated, then he or she may take a urine sample from the child to check for signs of an infection or other problem. Your pediatrician, in some cases, may also order tests or x-rays of the kidneys or bladder to see if there is a more serious underlying cause.
Things to keep in mind
- Almost all children respond to some type of therapy or combination of therapies. Many times, parents can become anxious and overly concerned about bedwetting. Pediatricians say it is important to be patient and realize that the problem will not go away instantly.
- It is common for children to experience some loss of self-esteem and feel embarrassment over their bedwetting. Explaining that this is a medical problem and assuring them that the problem eventually will be resolved can help a child's mental health a great deal.
- In the majority of cases, there will always be some successes and occasional relapses no matter what treatment you use. Be patient and accept that there will not be a magic bullet for the problem.
This article was reviewed and updated June 2007.
Return to the previous page
|
