Newswise — Nighttime bedwetting, or primary nocturnal enuresis, is a common condition in children, and most outgrow it. However, if bedwetting occurs after age 6 or 7, it may raise social and psychological issues.
About 15 percent of five-year-olds and about 5 percent of 10-year-olds wet the bed involuntarily unrelated to an underlying medical condition. The condition happens more often in boys than in girls and tends to run in families. Nighttime bedwetting becomes a real problem when it starts affecting children's socialization " when they can't go on sleepovers or attend camp.
Bedwetting is not due to a behavioral or mental problem or laziness of the child, says Paul Austin, M.D., associate professor of surgery at Washington University in St. Louis and a pediatric urologist at St. Louis Children's Hospital. Rather, some of the most common causes of bedwetting include:
"¢ Genetic factors: Children with one or both parents who wet the bed as children have a much higher risk of wetting the bed.
"¢ Problems with the kidney: lack of a hormone that is produced at night. The hormone, anti-diuretic hormone (ADH) or vasopressin, is produced normally at night to limit the formation of urine during sleep.
"¢ Problems with the brain: a full bladder fails to wake up the child.
"¢ Problems with the bladder: the bladder is too small for his or her age. The bladder should hold, in ounces, the child's age plus two.
All of these common causes are temporary and resolve as the child matures. Parents should exercise patience with their child and understand that their child is not wetting the bed on purpose. In addition, parents should encourage the child and let him or her know that they will eventually be able to stay dry at night, Austin says.
Some other steps parents can take include:
"¢ Limiting liquids two hours before bedtime.
"¢ Encouraging the child to go to the bathroom before bed.
"¢ Waking the child during the night to go to the bathroom.
"¢ Making sure the child gets enough rest and doesn't get overtired.
"¢ Avoiding foods before bed that may cause sensitivity or increase urine production, such as dairy, carbonated drinks, caffeine, chocolate, artificially colored drinks, candy, licorice, citrus and melons.
About 15 percent of children who wet the bed grow out of it each year, but if it pursues, there are several ways to treat the condition. Treatment is recommended when bedwetting impacts the child's self-esteem or socialization. Because of the different causes for bedwetting, treatment is tailored for each child.
Behavior modification techniques, such as a bedwetting or moisture alarm, can help when arousal is a strong component for the cause of bedwetting. The alarm is a small, battery-operated device that connects to underwear, a pad on the child's clothing or on bedding. When the pad senses wetness, an alarm goes off, waking the child and/or the parent so the child can go to the bathroom. With nightly repetition, the child's brain will associate bladder filling with arousal. This therapy works well in a motivated child.
When there is a large amount of urine produced at night by the kidney, a synthetic antidiuretic hormone medication called desmopressin can be prescribed to decrease the amount of urine produced. When the bladder appears to be small, another medication to help the bladder relax and hold more urine may be used or combined with the antidiuretic hormone medication.
"Children who take medication for the condition can take a break from the medication after six months," Austin says. "Within a week or two, families can quickly determine whether the child has outgrown the problem. If not, medication is prescribed for another six-month cycle. Over time, the bedwetting will eventually stop."
If a child doesn't respond well to standard treatment techniques, he or she can be referred to a pediatric urologist. Bedwetting could be a symptom of a urinary infection, painful urination, daytime incontinence, bowel problems, anatomic disorders or other problems.
Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
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