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My Child's Health  >>  Bedwetting

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Enuresis - Bedwetting

Bedwetting is involuntary urination in children over 5 to 6 years old. It may occur at any time of the day or night.

Symptoms

The main symptom is involuntary urination, usually at night, that occurs at least twice per month.

Causes

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 than twice per month after age 5 or 6, it is called bedwetting or nocturnal enuresis.

Bedwetting is 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 bedwetting episodes. Bed wetting runs strongly in families.

There are two types of bedwetting

- Primary enuresis: Children who have never been consistently dry at night. This usually occurs when the body makes more urine overnight then 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 child's or the parent's fault.

- Secondary enuresis: Children who were dry for at least 6 months start bed wetting again. There are many 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.

 

Traditional Medical Treatment Options and Diagnosis

A prescription medication called DDAVP (desmopressin) is available to treat bed wetting. It works by decreasing 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 secondary enuresis, your doctor will look for the cause of the bedwetting before recommending treatment.

Dr. Huntoon's Alternative Medical Treatment Options

Many times chiropractic adjustments will help to take the pressure off the nerves related to the bladder control mechanism. Removing the pressure on these nerves will allow the bladder to regain control of its voiding mechanism and allow for normal bladder control. Asking about what is involved and what commitment levels and time frame is important.

For the emotional problems associated with the underlying cause of bedwetting or the effects of the bed wetting, using NeuroEmotional Technique (NET) with a qualified practitioner is also warranted.

Treating with an Acupuncturist, Homeopath or Naturopath has also shown promise.

Expectations (prognosis)

This condition poses no threat to the health of the child if there is no physical cause of bedwetting. Though, the child may feel embarrassment or have a loss of self-esteem because of the problem, so it is important to reassure the child. Most children respond to some type of treatment.

Medicines Two Choices for You

Many parents are concerned when their child continues to wet their bed at night past the age of three years old. Since most children begin to stay dry through the night around three years of age their concerns are perfectly valid. However, child and adolescent psychiatrists stress that enuresis is a fairly common symptom and not a disease. Occasional accidents may occur, often when the child is ill. Parents need to be understanding, particularly if the child has been able to have a majority of dry nights.

Some facts parents should know about bedwetting:
- Approximately 15 percent of children wet the bed after the age of three
- Many more boys than girls wet their beds
- Bedwetting runs in families
- Usually bedwetting stops by puberty
- Most bedwetters do not have emotional problems
- Persistent bedwetting beyond the age of three or four rarely signals a kidney or bladder problem.

Bedwetting may sometimes be related to a sleep disorder. In most cases, it is due to the development of the child's bladder control being slower than normal. Bedwetting may also be the result of the child's tensions and emotions that require attention.

There are a variety of emotional reasons for bedwetting. For example, when a young child begins bedwetting after several months or years of dryness during the night (secondary enuresis), this may reflect new fears or insecurities. Often, this may follow changes or events which make the child feel insecure, such as: moving to a new home, parents divorce, losing a family member or loved one, or the arrival of a new baby or child in the home.

Parents should remember that children rarely wet on purpose, and usually feel ashamed about the incident. Rather than make the child feel ashamed, parents need to encourage the child and express confidence that he or she will soon be able to stay dry at night.

Parents may help children who wet the bed by:
- Limiting liquids before bedtime
- Encouraging the child to go to the bathroom before bedtime
- Praising the child on dry mornings
- Avoiding punishments
- Waking the child during the night to empty their bladder

Treatment for bedwetting in children usually includes behavioral conditioning devices (pad/buzzer) and/or medications if behavioral interventions are unsuccessful. In rare instances, the problem of bedwetting cannot be resolved by the parents, the family physician, or the pediatrician.

Sometimes the child may also show symptoms of emotional problems--such as persistent sadness or irritability, or a change in eating or sleeping habits. In these cases, parents may want to talk with a child and adolescent psychiatrist, who will evaluate physical and emotional problems that may be causing the bedwetting, and will work with the child and parents to resolve these problems. Early supportive intervention will help minimize the potential emotional impact of persistent bedwetting on the child.

What to Discuss with Your Doctor

Your child's doctor 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. A physical examination should be performed to rule out physical causes. A urinalysis will be done to rule out infection or diabetes. X-rays of the kidneys and bladders and other studies are not needed unless there is reason to suspect some other problems.

What to Discuss with Your Doctor

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Your Solution

Treatment
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. Bed wetting 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.

Complications
Complications may develop if a physical cause of the disorder is overlooked. Psychosocial complications may arise if the problem is not dealt with effectively in a timely manner.

Calling your health care provider
Be sure to mention bedwetting to your child's healthcare provider. Children should have a physical exam and a urine test to rule out urinary tract infection or other causes.

If your child is having pain with urination, fever, or blood in the urine, contact your child's doctor right away.

Prevention
Getting plenty of sleep and going to the bathroom at regular times during the day and night can help prevent some aspects of bedwetting.

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