Bed wetting (Enuresis)

What is Bed wetting (Enuresis)

Enuresis is the medical term for bed wetting during sleep. Bed wetting is fairly common among children and is often just a stage in their development. Bed wetting is more common among boys than girls.

Enuresis is an involuntary loss of urine or a leakage of urine. Children who have this condition may have accidents during the day (diurnal enuresis), at night (nocturnal enuresis), or both.

Enuresis is common in children who are younger than 5 years old, and it is not usually considered to be a problem until after age 5.

What causes bed wetting?

A number of things can cause bed wetting. Some of the more common causes of bed wetting include the following:

Bed wetting is not a mental or behavior problem. It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom.

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Stress
• Slower than normal development of the central nervous system (which reduces the child’s ability to stop the bladder from emptying at night)
• Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• A small bladder
• A slower than normal maturing of the bladder muscles.
• Making more urine at night.
• Emotional stress.

• A bladder infection.
• An overactive bladder.

• An underlying medical problem.
• Constipation.
• Being a very deep sleeper.

When do most children achieve bladder control?

Children achieve bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. Bed wetting up to 6 years of age is not unusual, even though it may be frustrating to parents. If a child is younger than 6 years of age, treatment for bed-wetting usually is not necessary.

How can my family doctor help?

Although most children who wet the bed are healthy, your doctor can help you determine whether your child’s bed-wetting is caused by a medical problem.

First, your doctor will ask questions about your child’s daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes.

Your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child’s bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home.

What are the treatments for bed wetting?

Usually, treatment is not needed. Most children eventually outgrow the condition. If enuresis becomes a social or psychological issue for your child or your family, treatment may include a combination of:

• Home behavioral training.
• Alarms that use a small sensor in the underwear. The alarm wakes the child after the first few drops of urine so that he or she can use the toilet.
• Medicines to:
  • Decrease the amount of urine that is made at night.
  • Increase bladder capacity.

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:

• Limit fluids before bedtime.
• Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
• Use an alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
• Create a reward system for dry nights.
• Ask your child to change the bed sheets when he or she wets.
• Bladder training: have your child practice holding his or her urine for longer and longer times during the day, in effort to stretch the bladder so it can hold more urine.

What kinds of medicines are used to treat bed wetting?

Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren’t a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

How can I help my child cope with wetting the bed?

Bed-wetting can lead to behavior problems because a child may feel guilt and embarrassment. It’s true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry).

But your child shouldn’t be made to feel guilty. It’s important for your child to know that bed-wetting isn’t his or her “fault.” Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Remind your child that it’s okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child’s mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

Follow these instructions at home:

General instructions

• Have your child practice holding in his or her urine. Each day, have your child hold in the urine for longer than the day before. This will help to increase the amount of urine that your child’s bladder can hold.
• Do nottease, punish, or shame your child or allow others to do so. Your child is not having accidents on purpose. Give your support to him or her, especially because this condition can cause embarrassment and frustration for your child.
• Keep a diary to record when accidents happen. This can help to identify patterns, such as when the accidents usually happen.
• For older children, do not use diapers, training pants, or pull-up pants at home on a regular basis.
• Give medicines only as directed by your child’s health care provider.

If Your Child Wets the Bed

• Remind your child to get out of bed and use the toilet whenever he or she feels the need to urinate. Remind him or her every day.
• Avoid giving your child caffeine.
• Avoid giving your child large amounts of fluid just before bedtime.
• Have your child empty his or her bladder just before going to bed.
• Consider waking your child once in the middle of the night so he or she can urinate.
• Use night-lights to help your child find the toilet at night.
• Protect the mattress with a waterproof sheet.
• Use a reward system for dry nights, such as getting stickers to put on a calendar.
• After your child wets the bed, have him or her go to the toilet to finish urinating.
• Have your child help you to strip and wash the sheets.

Contact a health care provider if:

• The condition gets worse.
• The condition is not getting better with treatment.
• Your child is constipated.
• Your child has bowel movement accidents.
• Your child has pain or burning while urinating.
• Your child has a sudden change of how much or how often he or she urinates.
• Your child has cloudy or pink urine, or the urine has a bad smell.
• Your child has frequent dribbling of urine or dampness.

Sources

• Primary Nocturnal Enuresis: Current Concepts  by M Cendron, M.D. ( 03/01/99,http://www.aafp.org/afp/990301ap/1205.html  )