Diseases & Conditions

Bed-wetting

Bed-wetting, also known as nighttime incontinence or nocturnal enuresis, isn't a sign of toilet training gone bad. It's often just a developmental stage.

Children who've never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.

Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, nighttime bladder control simply may not be established.

If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.

Bed-wetting is characterized by involuntary urination at night.

Most kids are fully toilet trained between ages 2 and 4 — but there's no target date for developing complete bladder control. During the preschool years, about 40 percent of children wet the bed. By age 5, bed-wetting remains a problem for only 10 percent to 15 percent of children.

The doctor may begin by asking questions about your child's health history and bed-wetting pattern. For example:

• Is there a family history of bed-wetting?
• Has your child always wet the bed, or did it begin recently?
• How often does your child wet the bed?
• Does the bed-wetting seem to be triggered by certain foods, drinks or activities?
• Is your child dry during the day?
• Is your child facing any major life changes or other stresses?
• Does your child complain of pain or other symptoms when urinating?
• If you're divorced, does your child live in each parent's home and does the bed-wetting occur in both homes?

Next, your child will need a physical exam. Depending on the circumstances, urine tests may be done to check for signs of an infection or diabetes. If the doctor suspects an anatomical abnormality or other problem, your child may need X-rays (radiographs) or other imaging studies of the kidneys or bladder.

Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.

Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.

Most children outgrow bed-wetting on their own. If there's a family history of bed-wetting, the child likely will stop at the age the parent did.

Limiting fluids before bedtime and double voiding — urinating at the beginning of the bedtime routine and then again just before falling asleep — may help.

You may want to encourage your child to delay daytime urination as well. If the bladder isn't completely full, the urge to urinate may fade within a few minutes. With practice, this simple "stretching exercise" may help your child's bladder hold more urine at night.

If your child is still wetting the bed by age 7 — and is motivated to stop — a doctor may recommend more aggressive treatment.

Moisture alarms
These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, and they may provide a better long-term solution than medication does.

Medication
If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:

• Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray. As of December 2007, however, only the pill form is approved to treat bed-wetting. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids.
• Change a child's sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has few side effects for bed-wetters. Caution is essential, however. An overdose could be fatal.
• Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin, Levsinex) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.

Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped.

Alternative therapies
Therapies such as massage, acupuncture and hypnosis have been touted as helpful treatments for bed-wetting. More research is needed before such therapies can be proved effective, however.