Bed-wetting, if untreated, can go on for years. It is reported that 13 percent of bed-wetting occurs in 6-year-olds while 5 percent occurs in children age 10 or older.

Bed-wetting in children below 7 is usually just a developmental stage, but if bed-wetting is still happening when the child is older than 7, then it is probably a condition called enuresis that may benefit from treatment.

Statistics show that approximately five million children in the United States have enuresis during the night.

There are many causes that can lead to bed-wetting:

• Family History – If there is a family history of bed-wetting by both parents when they were children, it puts the child at an 80 percent greater risk of developing enuresis

   

• Gender – Boys wet the bed more often than girls

   

• Attention Deficit Hyperactivity Disorder – Enuresis is more common in children with attention deficit hyperactivity disorder

   

• Lack of Bladder Development – Enuresis may occur because of the child’s urinary bladder not developing completely (small bladder) or the inability of the urinary bladder to hold urine during the night; for example, if the nerves of the bladder are not mature enough, they will not be able to wake the child up from sleep (inability to respond to need to urinate)

   

• Stress – Situations such as joining a new school, staying overnight away from home, or the arrival of a newborn sibling in the family that are stressful may cause bed-wetting

   

• Hormonal Imbalance –There may be a lower production of the anti-diuretic hormone that slows urine production during the night

   

• Sleep Apnea – the child’s breathing is interrupted in sleep usually due to enlarged tonsils or adenoids

   

• Urinary Tract Infection – a urinary tract infection may make it difficult for the child to control urination

   

• Diabetes – bed-wetting may be the first sign of diabetes; when combined with other signs like passing large amounts of urine at once, increased thirst, fatigue, and weight loss in spite of a good appetite, diabetes may be the issue

   

• Chronic Constipation– this can lead to reduced bladder capacity which can cause bed-wetting at night

   

• Anatomical Defect – very rarely, bed-wetting is related to defects in the urinary or neurological system.

A parent should consult a doctor if their child is wetting the bed especially if the child is complaining of pain or burning sensation during urination, swelling of feet and ankles are present, the child is wetting his or her pants during the day, and the child is misbehaving at school. These are indications of stress or other potentially serious conditions. It is best to discover the cause of enuresis so treatment can be implemented in a timely manner.

To diagnose enuresis a doctor performs a general physical examination of the child. The doctor notes the history of bed-wetting, as well as meal and sleep times.

A urine analysis is performed to check for any urinary tract infection or diabetes. If any problem in the bladder or kidney is suspected, X-rays and imaging studies are also performed to rule these out before making a diagnosis.

If bed-wetting runs in the family, then the child usually stops around the same age that the parents stopped. In this case, treatment involves management of the situation.

The level of treatment also greatly depends upon how the child feels about bed-wetting. If the child is embarrassed, the doctor usually outlines a more aggressive treatment plan.

A battery-operated device that detects moisture, known as a moisture alarm, can be purchased from a local pharmacy. This device is connected to a moisture-sensing pad that attaches to the pajamas of the child. The minute the child starts urinating, the wetness causes the device to sound an alarm, ideally waking the child up or waking up the parent so that the child can go urinate into the toilet. A moisture alarm requires patience because it takes approximately twelve weeks to achieve results.

If the doctor finds that a child’s bladder is too small, medications like hyoscyamine or an anticholinergic drug like oxybutynin are prescribed to increase the bladder’s capacity. Side effects can include flushed face and dry mouth.

Desmopressin is prescribed to increase the level of antidiuretic hormone that helps in making less urine during the night. Desmopressin should NOT be given to the child when they have taken lot of fluids or if the child is feeling nauseous with a headache. The most serious side effect of this drug is a seizure, so it should be administered exactly as outlined on the prescription.

To change a child’s sleeping and waking patterns, an antidepressant drug known as imipramine is sometimes prescribed. An overdose of this drug can be dangerous; therefore, it is prescribed only when other medications fail to help with improvement.

Strategy and Outlook

A parent should never punish their child for bed-wetting because it is an involuntary action and it is not malicious in any way. If the bed-wetting is due to some stress factor, the parent should first try talking to the child and calming their fears. A parent should be careful not to yell or tease the child because it may damage the child’s developing self-esteem.

For easy cleaning and management during treatment, covering the mattress with a plastic cover makes sense; absorbent underwear may also be worn by the child to minimize discomfort and clean up. Night-lights along the way to the bathroom will help the child reach the bathroom without tripping in the middle of the night. A parent should always avoid giving children cola, chocolates, and snacks with caffeine in the evenings because these may increase urination frequency and output.

Once the treatment has been started, it will take time to see progress so patience is a vital watchword.