A recent “explainer” posted on The Conversation will be welcome information for many parents. It’s about bed-wetting.
The writers of the report on The Conversation, an independent source of news and opinion for public consumption by members of Australia’s academic and research communities, are Caroline Walsh, a continence nurse at The Children’s Hospital at Westmead (Sydney), and Patrina Ha Yuen Caldwell, who heads the enuresis service for the hospital. “Enuresis” is lack of urinary control, especially nighttime bed-wetting.
Walsh and Caldwell say that bed-wetting, although embarrassing and traumatic, is common among children. It affects 15-20 out of 100 school-aged children, the vast majority of whom grow out of it. But there are treatments to hurry the evolutionary process.
Like adults, children usually wake up when they have a full bladder, but bed-wetters have a defective arousal response. They can’t wake fully. So when urine production exceeds bladder capacity, a child urinates in his or her sleep.
The disorder has a genetic link, so if you or your spouse had the problem, it’s more likely your kid will too. Bed-wetting is more common among boys, but women are more likely to pass the genetic inclination to their children. Gee, thanks mom!
Because bed-wetting carries such emotional baggage, and can affect a child’s self-esteem, mental health and early peer relationships, parents must handle the issue with sensitivity.
There are several treatments for bed-wetting, primarily alarm training, urotherapy and medication. Treatment is appropriate generally around the age of 6.
Usually, this is the first line of treatment, and the goal is to train the child to recognize the full-bladder signal before urinating in his or her asleep. There are two kinds of alarms:
- Pad and bell alarms connect a mat to an alarm box placed on the child’s bed. The alarm activates when the mat senses liquid.
- Personal alarm sensors are secured either in a panty liner or clipped to the child’s underpants. The alarm activates when the sensor detects liquid.
This method requires patience. It should be used every night until the child achieves 14 consecutive dry nights. It can take two to four months of training before the child reacts consistently enough to the signal to be deemed fully effective.
This covers a wide range of practices, primarily:
- ensuring the child has an adequate daily fluid intake (5 to 6 drinks per day that do not contain caffeine, including chocolate milk);
- avoiding the consumption of fluids late in the evening or close to bedtime;
- avoiding or readily treating constipation, which can affect bladder function;
- ensuring appropriate toilet posture, such as adequate foot support when sitting on the toilet (this supports complete evacuation of both the bowel and bladder);
- taking bathroom breaks regularly throughout the day, and encouraging the child not to postpone a trip to the toilet when the urge occurs.
This approach should be for a short-term solution or as a last resort. It relies on desmopressin, a synthetic hormone that has an anti-diuretic effect. It acts on the kidneys to reduce overnight urine production. Effective in about 7 in 10 child cases, desmopressin might be useful for sleep-overs or school camps when alarm training isn’t practical. It can also be combined with other treatments to ensure a dry night.
Like all medicines, desmopressin can prompt a negative reaction when combined with some other drugs, so make sure your pediatrician has a complete record of what your child takes.
Imipramine was one of the first medications used to treat nocturnal enuresis, but because of its risky side effects, including thoughts of harming or killing oneself, it’s not recommended as a first-line treatment.
Behavioral therapies can be helpful in treating bed-wetting. They include taking the child to the toilet during the night and rewarding him or her when he or she stays dry. “Try to create a positive environment and involve the child in decision-making,” the writers suggest, “so they can take ownership of the problem.”
But given the physiological nature of the disorder, psychological treatments often aren’t as effective as alarm training or medication.
Some complementary and alternative medicine interventions, such as hypnotherapy and acupuncture, have been tried, but the evidence to support their use is limited.
If your child doesn’t respond to common treatments, seek advice from a pediatric urologist. Or try to ride out what usually is a youngster’s affliction that does improve with age.