Bed-wetting is involuntary urination during sleep in children over age five. Typically around ages 3 to 5 years, children become able to sleep through the night without wetting. While infection or anatomic abnormalities of the urinary system may explain bed-wetting at night, most cases have no explanation and are referred to by doctors as primary nocturnal enuresis (PNE).
When children are sleeping, the bladder may signal the brain that it is full. But the brain must return a signal for the bladder not to empty. Then the child must wake up and go to the bathroom.
Causes of bed-wetting are varied and may overlap. Contributing factors include:
In rare cases, bed-wetting may indicate a physical problem. Usually if a physical problem is responsible, daytime urinary patterns will change as well. Physical conditions that may cause the condition include those in which either excess urine is produced or the bladder does not empty properly:
Unless a child has one of the conditions listed above, virtually all will stop bed-wetting by the time they reach puberty. However, bed-wetting remains a problem for up to 1% of adults.
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
The doctor will ask about symptoms and medical history, and perform a physical exam. Expect to answer questions about:
Tests may include:
The doctor may refer you to one or more specialists, such as an ear, nose, and throat doctor if there is evidence of obstructive breathing at night or a psychiatrist if there are significant emotional problems.
Treatment for aims to gradually reduce the frequency of bed-wetting until the child essentially grows out of it. Treatment is rarely appropriate before age six, which is usually when bed-wetting begins to interfere with social development.
Bed-wetting is rarely an intentional act. Children are usually upset and ashamed when it happens. Do not punish the child. It is very important that parents offer encouragement that the bed-wetting will stop with time. Do not let siblings tease the child who wets the bed. Keep careful records of the child's progress and offer consistent support. A very simple motivational method is the use of positive feedback, such as a star chart.
Fluids should be restricted after 6:00-7:00 in the evening, and the child should void before going to bed. Sugar and caffeine should also be avoided after late afternoon.
The doctor may recommend a conditioning device, such as a pad with a buzzer that sounds when wet. The child wears the pad in his underwear. The alarm wakes the child to get up and use the toilet. Parents may need to help the child get to the bathroom and reset the alarm.
Most studies suggest that this form of treatment has the highest success rate and the fewest complications. Adding another type of therapy, like dry bed training, can also help your child succeed. Dry bed training involves following a schedule where you awaken your child during the night so he can use the bathroom.
Some doctors suggest bladder-stretching exercises, but there is little evidence that this approach works. While awake, the child gradually increases the amount of time that elapses between urinations. Do not try this method without talking to the doctor.
Drugs to treat symptoms include:
Prevention of bed-wetting in children not prone to primary nocturnal enuresis (PNE) is of limited value. Since excess intake of fluid is rarely the cause, restricting fluids prior to bed does not produce consistent results. Still, it is reasonable to have all children empty their bladders prior to bed. Some parents wake their children every few hours to urinate, but most report that they rarely get much cooperation.
RESOURCES:
American Academy of Child and Adolescent Psychiatry
http://www.aacap.org
American Academy of Pediatrics
http://www.aap.org
CANADIAN RESOURCES:
About Kids Health
http://www.aboutkidshealth.ca
Alberta Health and Wellness
http://www.health.gov.ab.ca/
References:
American Academy of Pediatrics website. Available at: http://www.aap.org .
Campbell MF, Walsh PC, et al. Campbell's Urology . 7th ed. Philadelphia, PA: WB Saunders Company; 1998.
Conn HF, Rakel RE. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002: 720-721.
Facts for families: bed wetting. American Academy of Child and Adolescent Psychiatry website. Available at: http://www.aacap.org/cs/root/facts_for_families/bedwetting . Updated November 2002.
Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.
Lee T, Suh HJ, Lee HJ, Lee JE. Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone, or imipramine alone: a randomized controlled clinical trial. J Urol . 2005;174:1084-1087.
12/13/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements: Desmopressin acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray). US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Desmopressin . 2007 Dec 4.
9/23/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Glazener C, Evans J, Peto RE. Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews. 2004(1). CD004668. DOI: 10.1002/14651858.CD004668.
Last reviewed September 2009 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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