Bedwetting, also called nocturnal enuresis, means that a child accidentally passes urine at night during sleep. Because this is normal in infants and very young children, bedwetting is not considered a medical problem unless it happens in a child who is already in elementary school or who was completely dry day and night and then began to wet the bed again during the night. By age 5, 80% to 85% of children are consistently dry throughout the night. After age 5, the number of children who continue to wet the bed decreases by about 15% per year, even without treatment. Only 1% of children still wet the bed by the time they are 15 years old.
To help make diagnosis and treatment easier, doctors sometimes classify bedwetting into two types, primary and secondary nocturnal enuresis. In primary nocturnal enuresis, the child has never been consistently dry at night. In secondary nocturnal enuresis, the child has been dry at night for at least three to six months (or one year, according to some experts) and has begun to wet the bed again. It is very important to remember that in both types, the child is not wetting the bed on purpose.
Primary Nocturnal Enuresis
This is the most common type of nocturnal enuresis. Pediatricians think it is caused by several developmental, genetic and hormonal factors acting together.
Although the specific combination of factors varies from child to child, the result is the same -- bedwetting. In a small number of cases, primary nocturnal enuresis arises from a purely medical problem, such as a physical defect in the child's urinary tract, a neurological problem related to the spinal nerves or brain, or a urinary tract infection.
Secondary Nocturnal Enuresis
When a child starts to wet the bed again after being dry for months or sometimes even years, there is often an identifiable cause. One of the most common is stress, when a sudden change rocks a child's world. Almost any change in the environment -- good or bad -- can be a trigger; for example, a new baby, a death in the family, parents' divorce or marriage problems, a new home or school, or even a long visit from relatives. Secondary bedwetting may be related to sexual abuse or to extreme bullying. Rarely, this form of bedwetting is related to a medical problem, such as a urinary tract infection or diabetes, and in these cases there are usually other obvious symptoms of medical illness.
In most children with bedwetting, soaked sheets and wet pajamas are all that parents will see. In rare cases caused by a medical illness, such as urinary tract infection or diabetes, there may be other symptoms. It is especially important to watch for such symptoms in an older child who starts wetting the bed after having been dry in the past:
The doctor will ask about any family history of bedwetting. If one or both parents were affected during childhood, the doctor will want to know the age when a parent's bedwetting stopped. In many cases, a child's bedwetting will stop around the same age.
The doctor will ask about your child's eating and drinking habits, especially about drinking right before bedtime and eating snacks that melt into liquids, such as ice cream or gelatin desserts. In a child who has been dry in the past, your doctor will want to know about any unusual stresses, either at home or at school, that might be triggering the bedwetting.
To rule out medical illnesses and conditions as a cause of your child's bedwetting, the doctor will ask about additional symptoms related to a urinary tract infection or diabetes. The doctor will ask whether there is anything unusual about the way your child urinates, including straining during urination or changes in his or her urine stream.
The doctor will examine your child, paying special attention to your child's belly (abdomen), genital area and lower spine, looking for any physical changes in these areas. The doctor will order a test of your child's urine (urinalysis) to look for signs of a urinary tract infection or diabetes. In most cases, your doctor can make a correct diagnosis based on your child's age, the history of bedwetting, any additional symptoms, and the results of the physical examination and urine test.
If your child has symptoms that suggest a urinary tract infection, diabetes or other problems, additional tests may be needed. Children with primary nocturnal enuresis do not routinely need X-rays or other tests that measure bladder size, shape or function.
Almost all children stop wetting the bed by the time they reach their mid-teens, even without treatment. By age 15, only 1 of 100 children is not completely dry at night.
To help your child achieve his or her first dry night, try these suggestions:
Even after your child has become completely toilet trained, occasional accidents will happen. It is important that you remain calm and casual as you change the bed sheets and underpants. You can do this with your child's help. Do not show disgust or disappointment.
When bedwetting is caused by a medical problem, treatment depends on the specific diagnosis.
If your child has no specific medical problem causing him or her to wet the bed, but has never been dry at night, there are several treatment options:
One of the safest and most commonly used medications for treating bedwetting is desmopressin acetate (Concentraid, DDAVP, Stimate), a synthetic drug that is similar to the body's natural antidiuretic hormone. The initial treatment usually lasts for three to six months.
If desmopressin is successful in keeping the child dry during this treatment period, the drug is tapered gradually and eventually stopped. Often the problem returns after the child has stopped taking the medication. Some children can use this medication to stay dry only when needed, such as when the child is away at summer camp or at a friend's sleepover party.
Call your doctor immediately if your child starts wetting the bed after being dry for several months or if your child has symptoms of a urinary tract infection or diabetes.
Call your doctor to discuss whether treatment would be recommended for your child who has never been dry at night and has started elementary school.
Because almost all children eventually outgrow bedwetting, the outlook is excellent, even without treatment.
With treatment, the success rate depends on the type of therapy. Motivational therapy succeeds in about 25% of children, behavioral therapy in about 70%, and bladder training in about 66%. The success rate of the drug desmopressin acetate may be as high as 70% but varies widely in research studies.
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