WhenBed-Wetting Becomes A ProblemA Guide for Patients and their Families1Bed-wettingloss of urine duringsleepcan be a major problem for children.Bed-wetting is almost never done onpurpose or due to laziness on the childspart. The medical term for bed-wetting isenuresis (en-your-ee-sis). After toilet training, which usually occurs byfour years of age, many children have abrief period of wetting during the daytimeor at night. If bed-wetting is still occurringat age six or seven, you should speak to yourfamily doctor or pediatrician. In some cases, bed-wetting occurs withdaytime wetting and/or bowel problems.This may be a sign of a more seriousproblem, and it is important to speak to yourfamily doctor or pediatrician. In some casesbed-wetting may be related to a urinaryinfection, so every child should initially havehis or her urine tested by a doctor. What causes bed-wetting?As children grow older, they are usually ableto stop wetting the bed at night. However,many older children continue to wet thebed. This may be due to one or more of thefollowing reasons: Some children do not wake up whentheir bladder is full. Some children produce more urine duringsleep than do others. Some children have bladders that do nothold as much urine as other childrens do.Common bed-wetting is not a mental orlearning problem, and punishing your childis never a solution. In fact, a child who ispunished for wetting the bed can developemotional problems. When will my child stop bed-wetting?Most children outgrow bed-wetting.However, it is hard to say when bed-wettingwill stop. Every child is different. Anestimated five to seven million children inthe United States wet their beds. One out offive 5-year-olds are affected by thiscondition. By age 10, only one in 20 havethis problem. Some children may be veryupset by their problem and even havefeelings of personal failure. They may fearsleep-overs and having friends find outabout their bed-wetting.2Are there treatments for bed-wetting?Yes. Your doctor is the best source of information. Doctors who care forchildren have experience with bed-wetting.Treatments that may help include the following: Limiting fluid before bedtimeBy itself,this rarely works. Reasonable limitation offluids, especially drinks that have caffeine,such as colas, helps in a few cases. Waking the child at set times during thenightSome families find it helpful towake the child once or twice at night togo to the bathroom. This may help keepthe bed dry but rarely helps a child tostop bed-wetting. Special exercises to stretch or conditionthe bladderThese are usually notsuccessful. These should never be used ifyour child wets during the day or usuallyhas to rush to go to the bathroom. Moisture alarmsThese alarms often canhelp the child learn to feel when thebladder is full and when wetting is just3about to happen. The alarm consists of amoisture-sensing device attached to thepajamas that wakes the child with a loudsignal or vibrating alarm. However, bed-wetters do not always wake up to thealarms, which supports the idea thatmany of these children have a problemwaking up when their bladders are full.As long as someone is sure the childwakes up, the alarm may be successful.While it may take several weeks ormonths for the child to stay dry on his orher own, moisture alarms have thehighest long-term success rate. MedicationsSeveral different types ofmedications have been widely used totreat bed-wetting. Medicines may havesome side effects. Speak to your doctorabout whether these medicines would beright for your child. Your doctor mayrecommend a combination ofmedications and other treatmentmethods. Not all children respond tothese medications. DesmopressinThis is a man-made formof the hormone (antidiuretic hormone)that causes most people to make lessurine during sleep. This medication isavailable in pill form or as a nasal spray.It works by decreasing the urineproduced by the kidney, resulting in lessurine filling the bladder. Excessive fluidintake should be avoided when takingthis medication because waterintoxication may occur.45 ImipramineImipramine has been usedfor many years to treat bed-wetting. Thismedication may affect mood or behaviorin some patients. The medication is safewhen taken in the dose prescribed forbed-wetting. An overdose may bedangerous, however, so parents shouldcarefully supervise a child who is takingthe medication for bed-wetting. Themedication should be kept out of thereach of younger children in the house. Anticholinergics (HyoscyamineOxybutynin,Tolterodine )These aremedications that relax the bladder andallow it to hold more urine. They areoften used to help children who alsohave daytime wetting problems.Anticholinergics alone are usually noteffective for bed-wetting unless thechild has daytime wetting. In somecases, this medication may be used incombination with desmopressin tocontrol bed-wetting. Common sideeffects of anticholinergics include drymouth and facial flushing. HypnotherapyLimited studies haveshown that hypnotherapy helps somechildren. Further scientific study isneeded in this area. Herbal, acupuncture and chiropractictherapiesThere is no scientific proofthat these therapies work.COMMON QUESTIONSWill my child outgrow bed-wetting?Yes. What is not predictable is when yourchild will outgrow the problem. Only one totwo out of 100 bed-wetting children stillhave the problem by the time they reachage 15. Although very rare, bed-wettingmay continue into adulthood.Does bed-wetting run in families?Yes. If both parents were bed-wetters aschildren, then there is a 7 out of 10 chancethat their child will wet the bed. If oneparent was a bed-wetter, then there is a 4out of 10 chance. When should a child with bed-wetting have further testing?It is rare that a child with common bed-wetting needs to have further tests. Theymay be needed when the child has: new or persistent daytime wetting urinary infections bowel difficulties problems urinating.Some of the tests that may be done includeultrasound examination of the kidneys andbladder, x-rays or other tests.6Will bed-wetting affect my childin the long term?Effective treatment improves behavioral andemotional poblems sometimes associatedwith bed-wetting. You can help your child by: explaining bed-wetting to your child reassuring your child that bed-wetting isnot his or her fault and that it will goaway in time having open discussions with the childand siblings making arrangements with other parentsand camps so that sleep-overs arepossible and less threatening to the bed-wetting child.Is there a relationship between bed-wetting and attention deficitdisorder?Both attention deficit disorder and are common problems and are unlikely tocause each other. A bed-wetter withattention deficit disorder, however, may be somewhat less likely to respond to treatment.Will a developmentally delayedchild who wets the bed havemore trouble becoming dry?Children with developmental delay canbecome dry at night, but it may take longer7than usual. How much longer depends onhow severe the developmental delay is.Does bed-wetting mean that mychild has a kidney problem?No. Most children who wet the bed donot have any kidney problems. In a fewunusual cases, however, bed-wetting anddaytime wetting can reflect an underlyingkidney problem or a serious bladderproblem. Your doctor can look into these possibilities.My child didnt have a bed-wetting problem until his brother was born. Whatcaused this?Sometimes,children whowere dry atnight aftertoilettrainingbecome bed-wettersbecause ofstress such asa newschool, anew baby inthe family,or a family8crisis. This is called secondary enuresis. If thisshould occur, consult your doctor for follow-up. It is important for parents to realize thatthe child is not at fault. As with all otherchildren who have bed-wetting, emotionalsupport, reassurance and patience are themost important parts of any treatment plan.Should my child continue to useabsorbent products?Using absorbent products at night to protectthe bed will often reduce the frustrationlevel of a parent and/or child waking to wetsheets. Although a few experts think thismay prolong bed-wetting, no studies haveshown this to be true. Remember, avoid anymeasures that may be interpreted by thechild as punishment. If you have otherquestions ask your doctor.What if I have more questions?Your best source of information about bed-wetting is your doctor. You can also contactyour local National Kidney Foundationaffiliate or the national office at (800) 622-9010, or go on the Web towww.bedwetting-nkfonline.org9How to explain bed-wetting to your childHere is one example: Tell your child that it isthe kidneys job to make urine, which goesdown tubes into the bladder. The bladder islike a waterballoon thatholds theurine. There isa muscle gatethat holds theurine in. Whenthe bladder isfull it sends amessage to the brain andthe brain tellsthe gate toopen. Tell yourchild that, inorder to bethe boss of hisor her urine at night, all the parts need towork together: the kidneys must make just the rightamount of urine the bladder must hold it and tell thebrain when it is full then the brain must either tell the gateto stay closed until morning, or tell thechild to wake up to use the toilet. 10Morethan20millionAmericansoneinnineadultshavechronickidneydisease,andmostdontevenknowit.Morethan20 million others are at increased risk. TheNationalKidneyFoundation,amajorvoluntaryhealthorganization,seekstopreventkidneyandurinarytractdiseases,improvethehealthandwell-beingofindividualsandfamiliesaffectedbythesediseases, and increase the availability of allorgans for transplantation. Through its 51affiliatesnationwide,thefoundationconductsprogramsinresearch,profe-ssional education, patient and commu-nityservices,publiceducationandorgandonation. The work of the National KidneyFoundation is funded by public donations. 1993 National Kidney Foundation, Inc.2002 EditionK/DOQI Learning system(KLS)TM02-29All Rights Reserved.No part of this publication may be reproduced or transmitted inany form or by any means, electronic or mechanical, includingphotocopy, recording, or any information storage and retrievalsystem, without permission in writing from the National KidneyFoundation.Permission requests should be written and addressed to thepublications department of the National Kidney Foundation. 30 East 33rd StreetNew York, NY 100161-800-622-9010The development of this publication was made possible byan educational grant from Aventis Pasteur