Many
Older Children Struggle With Bedwetting
But treatments can correct
the problem, experts say
If you have been washing
your child's urine-stained bed sheets every morning for far too
many years, do not punish him—he may have a condition called
nocturnal enuresis.
That is 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.
Bedwetting
Is Treatable
What many parents do not
realize is that bedwetting is treatable, Cendron says. Unaware that
something can be done about it, many parents do not think of raising
the issue with their child's physician. And pediatricians may not
routinely ask 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."
Factors
That Contribute to Bedwetting in Children
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 is 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 is 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 is
important to differentiate between what is 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 1percent 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—a
condition called "secondary" nocturnal enuresis—you should
take the child to a pediatrician for a check-up, Goldson says.
While it is usually nothing
serious, it could in some cases mean a bladder infection or some
emotional trauma that is causing the problem, he adds.
Always consult your child's
physician for more information.
Online
Resources
(Our Organization is not
responsible for the content of Internet sites.)
American
Academy of Pediatrics (AAP)
National
Kidney Foundation
Proceedings
of the National Academy of Sciences
|
December 2002
Bedwetting
Is Treatable
Factors
That Contribute to Bedwetting in Children
What
Is Urinary Incontinence (Enuresis)?
What
Causes Urinary Incontinence?
How
Is Urinary Incontinence (Enuresis) Diagnosed?
Treatment
For Urinary Incontinence (Enuresis)
Online
Resources
What
Is Urinary Incontinence (Enuresis)?
Urinary incontinence (enuresis)
is a medical name for bedwetting, or the accidental urination in
children who should be developmentally able to have control of their
bladders. Girls usually have bladder control before boys do. The
diagnosis of enuresis is for girls over the age of 5 and for boys
over the age of 6 that are still having urinary control problems.
There are different types of bedwetting that may occur, including
the following:
-
diurnal
enuresis - wetting during the day.
-
nocturnal
enuresis - wetting during the night.
-
primary
enuresis - occurs when the child has never fully
mastered toilet-training.
-
secondary
enuresis - occurs when the child did have a period
of dryness, but then returned to having periods of incontinence.
What
Causes Urinary Incontinence?
There are many factors
that may be involved, and many theories that are given for why children
wet the bed. The following is a list of some of the possible reasons
for the problem:
-
-
delay of the ability
to hold urine (this may be a factor up to about the age of
5)
-
-
poor sleep habits
or the presence of a sleep disorder
-
a problem with the
proper functioning of hormones that help to regulate urination
How
Is Urinary Incontinence (Enuresis) Diagnosed?
Urinary incontinence (enuresis)
is usually diagnosed based on a complete medical history and physical
examination of your child. In addition to talking with you and the
child, your child's physician may perform the following to help
rule out other causes for the wetting:
-
urine tests (to
make sure there is not an underlying infection, or condition
such as diabetes)
-
blood pressure measurement
-
Treatment
For Urinary Incontinence (Enuresis)
Specific treatment for
enuresis will be determined by your child's physician based on:
-
your child's age,
overall health, and medical history
-
-
your child's tolerance
for specific medications, procedures, or therapies
-
expectations for
the course of the condition
your opinion or preference
Prior to starting treatment,
it is important to know that:
-
The child is not
at fault and should not be punished. The child cannot control
the wetting.
-
Enuresis is very
common among 5-year-olds.
Treatment may include:
-
positive reinforcement
of the child (i.e., the use of sticker charts for dry nights)
-
use of night-time
alarms to help tell the child when wetting is occurring
-
medications, as
prescribed by your child's physician (to help control the
wetting)
-
bladder training
to help increase the bladder size and the child's ability
to know when they have to urinate (this is done by having
the child wait as long as possible during the day to urinate
and let the bladder get full)
In addition, counseling
of the child and family may help to determine any stress the child
may be under. Strategies for reducing your child's stress will
be discussed. Always consult your child's physician for more information.
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