Bed-Wetting

Bed wetting is a common occurrence in many children.

Soggy sheets, pajamas and an embarrassed child is a common scene in millions of families.

Parents often tend to lose hope and believe bed-wetting is a sign of toilet training gone bad, but this is not true.

It is very common among young kids and may sometimes last into teenage years.

It is often a normal part of your child's development and children usually grow out of this problem.

Bed-wetting is also called nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before the age of 7 is not a serious concern.

At this age, nighttime bladder control may still be developing in your child.

If bed-wetting continues, it may last for a while, but handling the problem with patience, providing emotional support and reassuring your child may help him feel better.

Bladder training, moisture alarms or medication may help reduce bed-wetting.

There may not be any symptoms that indicate your child will wet the bed.

Bed-wetting is involuntary urination that occurs while asleep during the night even when a child has already developed bladder control.

Most kids are toilet trained by the age of 5, but this is not always a target date for developing complete bladder control.

Bed-wetting may continue as a problem in some children between the ages of 5 and 7.

A small percentage of children may still wet the bed beyond the age of 7.
Most children outgrow bed-wetting problem without any treatment or help.

In some cases, bed-wetting may be a sign of another medical condition that needs attention.

Consult your pediatrician if:

• Your child still wets the bed even after the age of 7
• Your child suddenly begins wetting the bed after being dry at night for about 6 months
• Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring at night

There are various causative factors that play a role in developing the problem of bed-wetting including:

• Bladder capacity: Your child's bladder may be small and may not be fully developed to hold all the urine that is produced during the night.
• Inability to recognize a full bladder: A full bladder may not awake your child, especially if your child is in deep sleep, because of the inability to recognize messages of the nervous system sent to the sleep arousal centers of the brain when the bladder is full.
• An imbalance in hormones: During childhood, some children may not produce sufficient amounts of the anti-diuretic hormone (ADH) to decrease nighttime production of urine.
• Stress: Stressful life changes— such as getting a sibling, going to a new school, or sleeping at a place away from home may trigger bed-wetting.
• Urinary tract infection: This infection can make it difficult for your child to hold back urine until he/she goes to the bathroom. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, reddish or pink urine, and pain during urination.
• Sleep apnea: Obstructive sleep apnea, a condition in which your child's breathing gets disturbed during sleep, often because of inflamed or enlarged tonsils or adenoids may cause bedwetting. Other signs and symptoms of sleep apnea include snoring, sore throat, frequent ear and sinus infections, or drowsiness during the day.
• Diabetes: Bed-wetting may be caused by diabetes in a child who is normally dry at night. Other signs and symptoms may include passing abnormally large amounts of urine at once, increased thirst, fatigue and unexpected weight loss in spite of a good appetite.
• Chronic constipation: The muscles that control urine excretion and stool elimination are the same. When constipation persists as a long term problem, these muscles also lose their function and cause bed-wetting during the night.
• A structural defect in the urinary tract or nervous system: In rare cases, bed-wetting may be due to a defect in your child's neurological system or urinary system.

After evaluation of the problem, if required, your child may be referred to a doctor who specializes in urinary disorders (pediatric urologist or nephrologist).

Here is some information that helps you get ready for your appointment, and what to expect from your doctor.
Before going to your appointment, keep a list of the following:

• All signs and symptoms, including the major ones that may seem unrelated to bed-wetting.
• Maintain a diary of your child's bathroom visits. Note when your child goes to the toilet, and whether he or she felt an urgency to urinate. Also, note the amount of fluid your child drinks, partcularly after dinner.
• Key personal information, including major stresses or recent life changes.
• All regular medications, vitamins and other supplements that your child is taking, and their doses.

Some basic questions to ask your doctor include:

• What may be the cause for my child's bedwetting problem?
• When do kids outgrow bed wetting?
• What treatments are available, and which one do you suggest?
• Are there any side effects?
• Are there any alternatives to the primary approach that you have recommended?
• Should I restrict my child's drinking of fluids?

Your doctor may ask you a number of questions that include:

• Do you have a family history of bed-wetting?
• Does your child always wet the bed, or did the problem begin recently?
• How often does your child wet the bed?
• Is there any time when your child does not wet the bed?
• Does your child wet the bed during the day?
• Does your child have stool accidents?
• Does your child complain of pain or other symptoms while passing urine?
• Is your child undergoing any major life changes or stresses?
• If you and your spouse have separated or divorced, does your child alternate living at each parents' home, and does the bed-wetting occur in both homes?

Further laboratory and radiological studies are for children with secondary bedwetting.

Your child will require a thorough physical examination.

Depending on your child's condition, your doctor may recommend following tests:

• Urinalysis with urine culture to check for signs of an infection or diabetes
• X-rays or other radiological studies of the kidneys or urinary bladder, to identify if there is a structural defect within your child's urinary tract or another health concern

Most of the time, children can outgrow their bed-wetting problem without any treatment.

Usually, if there has been a family history of bed-wetting, a child may stop bed-wetting around the age the parent stopped bed-wetting.

If your child does not bother or get embarrassed by bedwetting during the night, traditional home remedies may be effective.

However, in the case of the child being worried about wetting the bed during a sleepover, additional treatments may be attempted.

The child's motivation as well as the parent's plays an important role in the selection of treatment and its success.

If underlying causes of bed-wetting, such as constipation or sleep apnea are evident, those should be treated before any other treatment.

Treatment methods
   

• Moisture alarms: These are small, battery-operated devices that are available at most drugstores without a prescription. These are connected to a moisture-sensitive pad placed on your child's pants or bedding. As soon as this pad senses moisture, the alarm rings. Ideally, this moisture alarm make sound just as your child starts urinating — to wake your child up from bed, stop the urine stream and go to the toilet. If your child is a deep sleeper, another person should listen to the alarm and wake the child. If you try a moisture alarm, it usually needs at least 15 days to see any type of response and about 16 weeks to get rid of the bedwetting. Moisture alarms have been effective in many children as they are involved with a low risk of relapse or side effects, and provide a better long-term solution when compared to medications.
• Medication: Medications are tried as a last resort to stop bed-wetting.

Certain types of prescription medications can:

• Decrease nighttime production of urine: The drug desmopressin (DDAVP, others) boosts the levels of a natural hormone (anti-diuretic hormone, or ADH) that in turn allows the body to produce less urine in the night. Avoid drinking excess liquid with this medication as it can cause problems with low blood sodium levels and increase the potential for seizures. So, drinking only 8 ounces (237 milliliters) of fluid along with and after taking the medication is permissible. Do not give your child this medication if he or she has a headache or has the feeling of nausea or vomiting. Desmopressin may be given in short-term situations, such as while going to a camp. According to the Food and Drug Administration, nasal spray formulations of desmopressin (DDAVP Nasal Spray, DDAVP Rhinal Tube, others) should no longer be used in the treatment of bed-wetting as these are associated with serious side effects.
• Reduce contractions of the bladder: If your child's bladder is small, an anticholinergic drug such as oxybutynin (Ditropan XL) may help control bladder contractions and increase the bladder capacity. This medication is usually used along with other medications and is recommended only when other treatments have been ineffective. However, there is no medication that can completely cure the problem. Bed-wetting problems typically return when medication is discontinued.

Some people may be interested in trying alternative and complementary remedies for bed-wetting.

Alternative medicine is the use of a nonconventional approach instead of conventional medicine, whereas complementary medicine is a nonconventional approach used along with conventional medicine.

Therapies such as hypnosis and acupuncture have been effective in some circumstances, while other therapies do not have evidence to support their use.

• Hypnosis: Small trials with hypnosis along with suggestions of waking up in a dry bed or visiting the toilet in the night have established that this therapy can help some children stay dry throughout the night, but more research is needed required.
• Acupuncture: This ancient Chinese treatment involves the insertion of fine needles into specific parts in your body. Acupuncture can be effective in some children to stop bedwetting, but more research is needed.
• Diet: It is believed that certain foods affect our bladder functions and eliminating these foods from the diet can help in decreasing bed-wetting. This evidence is not established and further research is required.
• Chiropractic therapy: Chiropractic practice believes that if there is spine misalignment, normal functions of our body get affected. Spinal adjustments help in setting right few bodily functions. However, there is very little evidence about the use of chiropractic therapy in the treatment of bed-wetting.
• Homeopathy and herbal treatment: Although some people take homeopathic remedies and herbal products, none of these have been proved effective through clinical trials. Always talk to your child's doctor before doing any complementary or alternative therapy. If you opt for a nonconventional approach, ask your doctor whether it is safe for your child and ensure it does not have any interaction with any medications your child is taking.

Here are some lifestyle modifications that you can make at home to manage your child's bedwetting problem:

• Limit the amount of fluids your child drinks in the evening: Encourage your child to drink more fluids in the morning and early afternoon so that your child does not feel thirsty in the evening. But do not restrict drinking fluids if your child participates in sports practice or games during the evenings
• Avoid beverages and foods containing caffeine: As caffiene acts as a stimulant to the bladder, caffienated beverages should not be given to children at any time of day, and it is especially discouraged in the evening.
• Encourage your child for double voiding before going to bed: Double voiding is pssage of urine at the beginning of the bedtime routine and then again just before falling asleep.
• Remind your child that it is good to use the toilet during the night if needed: Use dim lights during the night so that your child can easily find the way to go to the bathroom.
• Encourage regular toilet use throughout the day: During the day and evening, ask your child to pass urine every two hours or so, or at least as often enough to avoid a feeling of urgency.
• Treat constipation: Your doctor may recommend a stool softener if constipation bothers your child
• Prevent rashes: To prevent a rash caused by wet underpants, help your child clean his or her bottom and genital area every morning. It may also help if a protective moisture barrier ointment or cream is applied to the affected area at bedtime. Your pediatrician may recommend appropriate products.

Parental methods

Children do not wet the bed to irritate their parents. Try to understand this and be patient with your child as you work through the problem together.

Be responsive to your child's feelings. Encourage your child to express his/her feelings if your child is anxious or stressed.

Offer your support and encourage your child if he/she is anxious regarding any stressful event.

When your child feels secure, the bed-wetting problem may get resolved. If required, discuss with your doctor about additional strategies to effectively deal with stress.

Plan for easy cleanup

Cover your child's bed with a plastic sheet. Let your child wear a thick, absorbent underwear during night that helps absorb the urine.

Keep some extra bedding and pants handy.

However, it is better to avoid the long-term use of diapers or disposable pull-up underwear.

Entrust some cleaning activities to your child

Perhaps, your child can rinse his or her wet underwear and pajamas, and place these clothes in a specific container for washing.

Taking the responsibility of some chores for bed-wetting may help your child gain more control over the situation. Celebrate your child's effort.

Bed-wetting is an involuntary activity, so it is not right to punish or tease your child for wetting the bed or reward him or her for staying dry.

Instead, you can praise your child for following the bedtime routine and helping in cleaning up following bedwetting.

Use a motivational sticker reward system if you think it might help your child.

With reassurance, support and understanding, your child can expect dry nights ahead.

There are various factors that have been associated with an increased risk of bed-wetting, which include:

• Gender: Bed-wetting may affect any person, regardless of being male or female, but it is thought be twice as common in boys than in girls.
• Family history: If one or both of the child's parents used to wet the bed as children, their children have a greater chance of wetting the bed
• Attention-deficit/hyperactivity disorder (ADHD): Bed-wetting is more common in children with ADHD.

Bedwetting is frustrating, but does not cause other health problems unless it has an underlying physical cause.

However, bed-wetting may give rise to certain issues in your child such as:

• A feeling of guilt and embarrassment, which may lead to low self-esteem
• Losing opportunities to participate in social activities requiring sleepovers and camp
• Rashes may develop on your child's buttocks and genital area if your child sleeps in wet underwear