Bed-Wetting

January 7, 2008

Bed wetting, called enuresis ("en-yur-ee-sis") in the medical profession, is common in children up to the age of five. Around 5 to 7 million children in the United States wet the bed, and it's more common among boys than girls.

By the age of 5 years, most children will achieve bladder control and they will no longer urinate in their sleep. Treating a child for enuresis before the age of 5 is not necessary - in fact, it is discouraged.

 

What Causes Bed-Wetting?

Enuresis in caused by a number of different things, but in most children the cause is simply not being able to hold urine for a long time because of a small bladder. A young child's central nervous system is also still developing, and this reduces the child's ability to stop the bladder from emptying at night.

Other causes of bed-wetting include the following:

  • Genetic factors (it tends to run in families)
  • Difficulties waking up from sleep
  • Hormonal factors: not enough antidiuretic hormone, which reduces the amount of urine made by the kidneys
  • Urinary tract infections
  • Abnormalities in the urethral valves in boys or in the ureter in girls or boys
  • Abnormalities in the spinal cord

Bed-wetting is NOT caused by drinking too much before bedtime or mental or behavioral problems.

 

Diagnosis of Enuresis

 

To diagnose enuresis in your child, your family doctor will ask questions about his or her daytime and nighttime bathroom habits. The doctor will also do a physical exam and a urine analysis. He will check for antidiuretic hormone levels and he will look for problems in the urinary tract and the bladder.

Most of the time, children who wet the bed are completely healthy, but the doctor will want to rule out any more serious causes.

Your doctor may also ask you about home and school life for your child. Although most children who wet the bed are not more likely to be emotionally upset than other children, the doctor may ask about these things because treatment may depend on changes at home.

 

Enuresis Treatment

 

In the vast majority of cases, treatment for bed-wetting is not necessary - your child will grow out of it with time. However, if your doctor decides your child needs treatment, there are two kinds of treatment: medication and behavior therapy.

Behavior therapy is used before medication is considered in most cases. Behavior therapy centers on teaching your child not to wet the bed. Some techniques include:

  • Using an alarm that sounds when the bed gets wet at night. This teaches your child to respond to bladder sensation at night.
  • Rewarding your child for dry nights
  • Having your child change his or her own sheets when he or she wets the bed
  • Bladder training: having your child practice holding his or her urine for longer and longer times.

If your child if 7 years or older and behavior therapy hasn't worked, your doctor may prescribe a medication. One type of medication helps the bladder hold more urine, whereas the other type helps the kidneys make less urine. Medications are not meant as cures and they will most likely have side effects.

 

Your Child's Feelings About Bed Wetting

 

Wetting the bed may make your child feel embarrassed or guilty. Make sure to make it clear to your child that it's not his "fault" if he wets the bed. Explain that it sometimes runs in families, and if you used to wet the bed as a child, make this known. Tell your child that it is normal for lots of kids. Under no circumstances should you punish your child for wetting the bed.

There are also special "big kid" nighttime diapers and heavily lined underwear that your child can wear to help keep bed wetting under control.

 

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