Bedwetting (Enuresis)

Enuresis (Bed wetting)

Bed wetting, also known as primary enuresis or nighttime incontinence, is a common condition in which a child empties his or her bladder during sleep without being aware of it. Bed wetting can be a stressful and embarrassing condition that begins in early childhood and, for some children, extends into the preteen and teenage years. Although most children remain dry through the night by age 5, about 15% of 6-year-olds wet the bed. Boys are twice as likely as girls to wet the bed. Although doctors don’t really know why bed wetting occurs, it is likely due to several factors. Heredity plays a large role; most children who wet the bed have close relatives who suffered from bed wetting as children. Small bladder capacity, too much urine production, and an inability of the body to sense that the bladder is full or emptying during sleep can contribute to bed wetting.

Children who experience primary enuresis should be reassured that wetting the bed is not their fault and will eventually stop on its own. However, an older child’s bed wetting may bring parents to the child’s doctor to learn ways to cope with the situation. Several lifestyle changes may make bed wetting less likely, such as using the bathroom at bedtime and limiting fluid intake in the hours just before sleeping. Some children benefit from the use of moisture sensors, which make a noise or vibrate when the nightclothes are first wet. The use of medications to treat bed wetting is somewhat controversial. Although there are effective drugs to treat bed wetting, the condition returns when the drugs are stopped. This approach may be best used when the child will be away at camp or overnight at a friend’s house.

Bed Wetting Common in Childhood
In most cases, bed wetting is a natural part of childhood and does not signal a serious problem. Therefore, it is important for parents to support and reassure their child that the situation is not their fault and that it will someday stop on its own. Children should be allowed to change wet sheets if it will make them feel that they are helping in some way. The mattress should be protected by plastic sheets or pads to prevent the odor of urine from remaining in the room. Siblings should be strictly forbidden to make fun of the child’s bed wetting.

Consulting a Doctor
It is often helpful to discuss a child’s bed wetting with the doctor. Although only about 1% of all bedwetting is related to a physical problem or disease, a child’s pediatrician may recommend a number of tests to rule out physical conditions that could cause bed wetting in older children. A consultation with a pediatric urologist is sometimes prescribed if it appears the bed wetting is due to a treatable medical condition.

Some doctors recommend bladder-stretching exercises to help the bladder adjust to holding more urine before it empties. These exercises may help some children. Some older children (age 7 or 8 and up) and teens respond well to moisture alarms, which wake them so that they can empty their bladder on the toilet. Continued nightly use of such an alarm will eventually train most children to sense when their bladder is beginning to empty and wake them up before they begin to urinate. After a few weeks of dry nights, the child is usually able to discontinue the use of the alarm altogether. Moisture alarms are available in many pharmacies or through reputable mail-order companies that offer money-back guarantees.

If bed wetting begins suddenly after a long period of dry nights, parents should investigate the cause during a visit with the child’s doctor. This is important because a sudden onset of bedwetting can be a sign of an infection, diabetes, bladder disorders, or a reaction to a significant stressful event.

Drugs to Help Treat Bed wetting
Desmopressin acetate, or DDAVP, works by reducing the amount of urine produced during the night. It can be taken in oral form or as a nasal spray. It is given before bedtime and begins to work quickly. Although it has few side effects, DDAVP can cause water intoxication and seizures in children who drink excess water before bed time. It is important that children who take DDAVP drink no more than the amount of fluid indicated in the prescribing instructions before they go to sleep.

Imipramine is an antidepressant that has been used for years in the treatment of bed wetting. It is not known exactly how it works, but it is thought to reduce the amount of urine produced, help the bladder hold urine longer, and change the sleep cycle itself. It works best in older children and must be carefully controlled by an adult, as an accidental overdose can be fatal.

Anticholinergic drugs, such as oxybutynin and hyoscyamine, are used mostly in children who have daytime and nighttime wetting. These medications work by increasing the amount of urine the bladder can hold and reducing the bladder contractions that lead to urination. The primary side effects are facial flushing (especially in hot weather) and dry mouth. When treatment of bed wetting is unsuccessful using DDAVP alone, it may be helpful to add an anticholinergic drug, since both medications work in different ways.

Your pharmacist can answer any questions you may have about medications or moisture alarms used to treat bed wetting.

US Pharmacist
Copyright 2005 Jobson Publishing, LLC