Many Older Children Struggle With Bedwetting

But treatments can correct the problem

SATURDAY, Nov. 23, 2002 (HealthDayNews) -- If you've been washing your child's urine-stained bed sheets every morning for far too many years, don't punish him -- he may have a condition called nocturnal enuresis.

That's the medical term for bedwetting, a common problem that affects an estimated 5 million to 7 million older children in the United States.

Children generally stop wetting the bed by age 3, says Dr. Marc Cendron, a professor of surgery (urology) and pediatrics at Children's Hospital at Dartmouth in Lebanon, N.H.

Though kids may have the occasional "accident" up to about age 5, children who are still wetting the bed on a regular basis after that probably have nocturnal enuresis. The problem, which is more common in boys than in girls and can run in families, can sometimes persist throughout the teen years.

What many parents don't realize is that bedwetting is treatable, Cendron says. Unaware that something can be done about it, many parents don't think of raising the issue with their child's doctor. And pediatricians aren't doing a good job of routinely asking whether bedwetting is an issue with the child, Cendron adds.

They should. Nocturnal enuresis is very common in older children. About 20 percent of 5 year olds wet the bed, according to the American Academy of Pediatrics, as do about 10 percent of 6-year-olds and 3 percent of 12-year-olds.

"What I find almost outrageous is there are treatments out there and kids can get help and support and they're not offered by doctors," Cendron says. "There are a lot of kids out there who have this problem, and it's not addressed as well as it should be."

Two factors can contribute to bedwetting in children. The first is underdeveloped internal signals to wake the child when he or she needs to urinate.

"Bedwetters are in a situation where the bladder is not communicating with the brain," Cendron explains. "The bladder empties spontaneously without the brain knowing it."

One method of developing these internal signals is by having the child wear pajamas or underwear that have a moisture sensor, which sets off an alarm when the child starts to urinate.

Because most children with nocturnal enuresis are deep sleepers, there's a good chance the child will sleep right through the alarm -- but the rest of the family will wake up.

Even if the parents have to then wake the child and take him to the bathroom, repeating the process night after night can help the child learn to wake himself, Cendron says.

A second option is medication.

One type decreases the amount of urine produced at night. Children who wet the bed tend to have low levels of a hormone called antidiuretic hormone, which regulates urine production by the kidneys, Cendron says.

The hormone helps the kidneys retain water, thereby reducing the amount of urine filling the bladder. Low levels of the hormone means a child tends to produce a lot of urine at night.

A medication called DDAVP can reduce the amount of urine the kidneys produce at night. It may also help a child wake more easily at night, Cendron says.

Another option is imipramine, an anti-depressant that can have a similar effect. But imipramine can cause nausea, insomnia and dry mouth. In high dosages, imipramine can also cause irregular heartbeats and even death, Cendron says. For those reasons, he rarely prescribes it.

What's certain is that punishing or berating the child is never the solution, says Dr. Edward Goldson, a professor in the department of pediatrics at the University of Colorado Health Sciences Center.

"It simply doesn't help, and it can be counterproductive," Goldson says. "By blowing it up and embarrassing the child, you will not accomplish what you want, which is nighttime dryness."

Parents can understandably get extremely frustrated by a child who wets the bed, mistakenly believing the child is "acting out" and wetting on purpose, Goldson says.

Making matters worse, siblings can tease. And the child can be too embarrassed to go to sleepovers or to camp. Wetting the bed can also damage the child's self-esteem, especially if parents blame him.

"As the child gets older, it can be a huge psycho-social stressor," Cendron says. "It can cause some real psychological difficulties."

Wetting the bed runs in families. If both parents wet the bed when they were kid, their child has a 70 percent chance of being a bed wetter, according to the National Kidney Foundation.

The good news is about 15 percent of children who wet the bed stop wetting spontaneously with each successive birthday, Cendron says.

Only about .01 percent of adults still wet the bed, he says.

The best thing for parents to do is reassure the child that he will stop wetting the bed in time and, if it persists, to get treatment.

One final note: It's important to differentiate between what's known as "primary" nocturnal enuresis from "secondary" nocturnal enuresis. "Primary" means the child never had control of his bladder at night.

With primary nocturnal enuresis, less than one percent of the cases are caused by some underlying medical problem, such as diabetes or kidney or bladder infections, according to the American Academy of Pediatrics.

But if a child has control of his bladder and then starts wetting the bed later in life -- "secondary" nocturnal enuresis -- you should take the child to a pediatrician for a check-up, Goldson says.

While it's usually nothing serious, it could in some cases mean a bladder infection or some emotional trauma that's causing the problem, he adds.

What To Do

For more information on the causes and treatments of bedwetting, check with the National Kidney Foundation or the American Academy of Pediatrics.

SOURCES: Marc Cendron, M.D., professor of surgery (urology) and pediatrics, Children's Hospital at Dartmouth, Lebanon, N.H.; Edward Goldson, M.D., professor, department of pediatrics, University of Colorado Health Sciences Center, Denver
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