Bed-wetting / nighttime incontinence / nocturnal enuresis
- By sahlhealth
- May 18, 2021
- 23 views
Bed-wetting â€” also called nighttime incontinence or nocturnal enuresis â€” is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.
Soggy sheets and pajamas â€” and an embarrassed child â€” are a familiar scene in many homes. But don’t despair. Bed-wetting isn’t a sign of toilet training gone bad. It’s often just a normal part of a child’s development.
Generally, bed-wetting before age 7 isn’t a concern. At this age, your child may still be developing nighttime bladder control.
If bed-wetting continues, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medication may help reduce bed-wetting.
Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.
When to see a doctor
Most children outgrow bed-wetting on their own â€” but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.
Consult your child's doctor if:
- Your child still wets the bed after age 7
- Your child starts to wet the bed after a few months of being dry at night
- Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring
Depending on the circumstances, your doctor may recommend the following to identify any underlying cause of bed-wetting and help determine treatment:
- Physical exam
- Discussion of symptoms, fluid intake, family history, bowel and bladder habits, and problems associated with bed-wetting
- Urine tests to check for signs of an infection or diabetes
- X-rays or other imaging tests of the kidneys or bladder to look at the structure of the urinary tract
- Other types of urinary tract tests or assessments, as needed
Most children outgrow bed-wetting on their own. If treatment is needed, it can be based on a discussion of options with your doctor and identifying what will work best for your situation.
If your child isn't especially bothered or embarrassed by an occasional wet night, lifestyle changes â€” such as avoiding caffeine entirely and limiting fluid intake in the evening â€” may work well. However, if lifestyle changes aren't successful or if your grade schooler is terrified about wetting the bed, he or she may be helped by additional treatments.
If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment.
Options for treating bed-wetting may include moisture alarms and medication.
These small, battery-operated devices â€” available without a prescription at most pharmacies â€” connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off.
Ideally, the moisture alarm sounds just as your child begins to urinate â€” in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm and wake the child.
If you try a moisture alarm, give it plenty of time. It often takes one to three months to see any type of response and up to 16 weeks to achieve dry nights. Moisture alarms are effective for many children, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does. These devices are not typically covered by insurance.
As a last resort, your child's doctor may prescribe medication for a short period of time to stop bed-wetting. Certain types of medication can:
- Slow nighttime urine production. The drug desmopressin (DDAVP) reduces urine production at night. But drinking too much liquid with the medication can cause problems, and desmopressin should be avoided if your child has symptoms such as a fever, diarrhea or nausea. Be sure to carefully follow instructions for using this drug.
Desmopressin is given orally as a tablet and is only for children over 5 years old. According to the Food and Drug Administration, nasal spray formulations of desmopressin (Noctiva, others) are no longer recommended for treatment of bed-wetting due to the risk of serious side effects.
- Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) may help reduce bladder contractions and increase bladder capacity, especially if daytime wetting also occurs. This drug is usually used along with other medications and is generally recommended when other treatments have failed.
Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when
medication is stopped, until it resolves on its own at an age that varies from child to child.
No one knows for sure what causes bed-wetting, but various factors may play a role:
- A small bladder: Your child's bladder may not be developed enough to hold urine produced during the night.
- Inability to recognize a full bladder: If the nerves that control the bladder are slow to mature, a full bladder may not wake your child â€” especially if your child is a deep sleeper.
- A hormone imbalance: During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
- Urinary tract infection: This infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination.
- Sleep apnea: Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep â€” often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring and daytime drowsiness.
- Diabetes: For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
- Chronic constipation: The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
- A structural problem in the urinary tract or nervous system: Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.
Bed-wetting can affect anyone, but it's twice as common in boys as in girls. Several factors have been associated with an increased risk of bed-wetting, including:
- Stress and anxiety: Stressful events â€” such as becoming a big brother or sister, starting a new school, or sleeping away from home â€” may trigger bed-wetting.
- Family history: If one or both of a child's parents wet the bed as children, their child has a significant chance of wetting the bed, too.
- Attention-deficit/hyperactivity disorder (ADHD): Bed-wetting is more common in children who have ADHD.
Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. However, bed-wetting can create some issues for your child, including:
- Guilt and embarrassment, which can lead to low self-esteem
- Loss of opportunities for social activities, such as sleepovers and camp
- Rashes on the child's bottom and genital area â€” especially if your child sleeps in wet underwear