Description

Bed-wetting — also called nighttime incontinence or nocturnal enuresis — means the passage of the urine unintentionally while he slept. This occurs after the age at which staying dry at night can be reasonably expected.

Soggy sheets and pajamas — and a child embarrassed — it's a familiar scene in many homes. But don't worry if your child wets the bed. Bedwetting is not a sign of problems with the training. It is often only a part of the typical development of a child.

In general, bed-wetting before age 7 isn't a concern. At this age, your child may still be in development, control of the bladder during the night.

If your child is still wetting the bed, to treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms, and, sometimes, medication can help to decrease the wetting the bed.

Symptoms

The majority of children fully trained by age 5, but there really is not a set date to have full control of the bladder. Between the ages of 5 and 7, wetting the bed, continues to be 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— but some need a little help. In other cases, bedwetting can be a sign of an underlying condition that requires medical attention.

Talk with your child's doctor or other health care professional if you:

  • Your child still wets the bed after 7 years of age.
  • The child begins to wet the bed after a couple of months of being dry during the night.
  • In addition to wetting the bed, your child has pain when urinating, often is extra thirsty, has pink or red urine, have hard stools or hoarse.

Causes

It is not known with certainty what causes bed-wetting. Several problems may play a role, such as:

  • A small bladder. Your child's bladder may not be developed enough to hold all of the urine produced during the night.
  • There is No awareness of a full bladder. If the nerves that control the bladder are of slow growth, a full bladder may not wake your child. This can be especially true if your child is a deep sleeper.
  • A hormonal imbalance. During childhood, some children do not produce enough anti-diuretic hormone, also called ADH. ADH slows down the amount of urine that is performed during the night.
  • Urinary tract infection. It is also called a urinary tract infection, this infection may make it difficult for your child to control the urge to urinate. Symptoms may include bed-wetting, the day of the accident, the passage of the urine often red or pink urine, and painful urination.
  • Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea. Sleep apnea is when a child's breathing is interrupted during sleep. This is often due to inflammation and irritation, or enlarged tonsils or adenoids. Other symptoms may include snoring and sleep during the day.
  • Diabetes. For a child that is usually dry at night, bed-wetting may be the first sign of diabetes. Other symptoms may include the removal of large amounts of urine at the same time, increased thirst, extreme tiredness, and weight loss despite a good appetite.
  • The constipation. A child who is constipated, you don't have bowel movements often enough, and the stool can be hard and dry. When the constipation is long-term, the muscles involved in the passage of urine and feces may not work well. This can be linked to bed-wetting.
  • A problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a difference in the structure of the urinary tract or nervous system.

Risk factors

Bed wetting can affect anyone, but is twice as common in boys as in girls.

Several factors have been linked to an increased risk of wetting the bed, including:

  • Stress and anxiety. Stressful events can trigger bed-wetting. Examples include the fact of having a new baby in the family, starting a new school or sleepovers.
  • The history of the family. If one or both of the parents of a child to wet the bed as children, their children have a greater chance of wetting the bed, too.
  • Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD .

Complications

Although frustrating, wetting the bed without a physical cause does not imply health risks. But bed-wetting may create some issues for your child, including:

  • The guilt and shame, which can lead to low self-esteem.
  • The loss of opportunities for social activities, such as sleeping outside of the home and the field.
  • Flares at the bottom and genital area, especially if your child sleeps in underwear wet.

Diagnosis

Depending on your child's situation, the health care professional can check for any underlying cause of bed-wetting. A treatment plan can be based on:

  • Physical exam.
  • Discuss the symptoms, fluid intake, family history, bowel and bladder habits, and the problems caused by bed wetting.
  • Urine tests to check for signs of infection or diabetes.
  • X-rays or other imaging tests of the kidneys and the bladder in order to observe the structure of the urinary tract.
  • Other types of urinary tract tests or assessments, if necessary.

Treatment

Most children outgrow bed-wetting on their own. If treatment is needed, talk about the options of your child's health care professional. Together you can decide what works best for your child.

If your child is not particularly bothered or embarrassed by an occasional damp of the night, lifestyle changes may work well. These include not having caffeine, the limitation of liquids in the night and the passage of urine before going to sleep.

If lifestyle changes are not successful, or if the child is upset or worried about wetting the bed, other treatments may be helpful.

If found, the underlying causes of bed-wetting, such as constipation or sleep apnea, you should be examined by a health care professional.

Options for the treatment of enuresis may include the humidity of the alarms and medicine.

Humidity alarms

These small, battery-operated devices connect to a moisture-sensitive pad on the child's pajamas or bedding. When the pad senses the humidity, the alarm is turned off. You can buy these moisture alarms without a prescription in most pharmacies.

Ideally, the humidity, the alarm only sounds when your child starts to pass urine. This should be in the time to help your child to wake up, stop the flow of urine and make it to the bathroom. If your child is a heavy sleeper, another person may need to hear the alarm and wake the child.

If you try the humidity alarm, give you a lot of time. It often takes 1 to 3 months to see any kind of response. It may take up to 16 weeks to have dry nights. Moisture alarms are effective for many children. Carry a low risk of side effects and may provide a better long-term solution to the medicine makes. These devices may not be covered by the insurance.

Medicine

If lifestyle changes do not help your child stay dry, your child can prescribe medicine for a short period of time to stop wetting the bed. Certain types of medications, you can:

  • Slow the amount of urine that is made at night.The drug desmopressin (DDAVP) reduces the amount of urine that is made at night. But drinking too much liquid with the medicine can cause problems. Do not use desmopressin if your child has symptoms such as fever, diarrhea, or nausea. Be sure to follow carefully the instructions for the use of this medication. Desmopressin is an oral tablet. It is only for children 6 years of age or older. According to the Food and Drug Administration, the nasal spray forms of desmopressin are not recommended for the treatment of nocturnal enuresis due to the risk of serious side effects.
  • The calm of the bladder. If your child has a small bladder, an anticholinergic drug, such as oxybutynin (Ditropan XL) can help to reduce spasms of the bladder and increase the amount of urine the bladder can hold. This can be especially useful if the day is wet also occurs. This medicine is usually used along with other medicines. Usually only recommended when other treatments have failed.

Slow the amount of urine that is made at night. The drug desmopressin (DDAVP) reduces the amount of urine that is made at night. But drinking too much liquid with the medicine can cause problems. Do not use desmopressin if your child has symptoms such as fever, diarrhea, or nausea. Be sure to follow carefully the instructions for the use of this medication.

Desmopressin is an oral tablet. It is only for children 6 years of age or older. According to the Food and Drug Administration, the nasal spray forms of desmopressin are not recommended for the treatment of nocturnal enuresis due to the risk of serious side effects.

Sometimes, your child may prescribe more than one type of medicine. But there are no guarantees that the medicine, and the medicine doesn't cure the problem. Bedwetting typically begins again when the medicine is stopped. This can happen up wetting the bed ends on your own at an age that varies from child to child.

Lifestyle and home remedies

Here are the changes that you can do at home that can help with bed-wetting:

  • Limit the intake of fluids at night. It is important to get a sufficient amount of liquid, so there's no need to limit the amount of your child drink in a day. But to encourage the consumption of fluid in the morning and early afternoon. This can reduce the thirsty in the night. But don't limit night of fluids if your child has the practice of sports or games in the night.
  • Avoid beverages and foods with caffeine. Caffeine is not a good idea for the kids any time of the day. Because the caffeine can stimulate the bladder, should be avoided, especially at night.
  • Urge to double voiding before bedtime. Double voiding is the passage of urine at the start of the routine to go to sleep and again just before falling asleep. Remind your child that it is okay to use the bathroom during the night if needed. The use of small night lights, so that your child can easily find your way between the bedroom and the bathroom.
  • Urge to regulate the use of the toilet throughout the day. During the day and the night, suggest to your child to pass urine every 2 to 3 hours or so, or at least frequently enough to avoid a feeling of needing to urinate immediately.
  • Prevent flares. To prevent a rash caused by the wet underwear, help your child to rinse its lower part and in the genital area every morning. It can also help cover the affected area with a barrier protection against moisture in the form of a cream or ointment at bedtime. Ask your health care professional for product suggestions.

Alternative medicine

Alternative medicine is a popular name for health care practices that traditionally are not part of well-researched standard of medicine. Complementary and integrative medicine, when they are based on solid research, it can sometimes be used in conjunction with the standard of medicine.

Some people may choose to use complementary or alternative medicine approaches for the treatment of bedwetting. For hypnosis, acupuncture, chiropractic therapy and herbal therapy, evidence of efficacy is weak, inconclusive or proven to not be effective. In some cases, the studies were too small or not this is done with care, or both.

Be sure to talk with your child's health care professional before starting any complementary or alternative therapy. If you select a method that is not standard, ask if it is safe for your child. Also make sure that you are not going to interact with the medications that your child can take.

Coping and support

Children do not wet the bed to disturb their parents. Try to be patient as you and your child work through the problem together. Effective treatment may include a variety of strategies and can take time to succeed.

  • Be sensitive to the feelings of your child. If your child is stressed or anxious, encourage your child to express those feelings. Offer support and encouragement. When your child is feeling calm and secure, bed-wetting may become less of a problem. If necessary, talk with your health care professional about other strategies to help deal with stress.
  • Plan for easy cleaning. Put a plastic cover over the mattress of his son. The use of thickness, underwear absorbent in the night to help contain the urine. Keep the bedding and pyjamas of the hand. But, avoid long-term use of diapers or disposable pull-up underwear.
  • Ask your child to help. If your child is old enough, consider asking your child to rinse wet underwear and pajamas or place these items in a specific container for washing. Taking responsibility of bed wetting can help your child feel more control over the situation.
  • Celebrate the effort. Praise your child for following the bedtime routine and help clean up after accidents. The use of a sticker reward system if you think that this could help to motivate your child. Wetting the bed is not done on purpose, so it makes no sense to punish or make fun of your child for wetting the bed. For the same reason, rewarding, dry nights is not useful. Also, discourage the brothers of the teasing of the child who wets the bed.

With the support and understanding, your child can look forward to the dry nights ahead.

Preparing for your appointment

It is likely to start by seeing your pediatrician or other health care professional. You may be referred to a doctor who specializes in urinary disorders, called a pediatric urologist or nephrologist pediatric.

Here's some information to help you prepare for your appointment and know what to expect.

What you can do

Before your appointment, make a list of:

  • Any of the symptoms, including important that may seem unrelated to wet the bed. Consider keeping a journal of your child's bathroom visits, and wet and dry nights. Note when the child goes to the bathroom and if the child felt the need to urinate immediately. Also note the amount of fluid your child drinks, especially after dinner.
  • Key personal information, including any major stresses or recent life changes.
  • Any family history of enuresis, including siblings or parents.
  • All the drugs, vitamins, herbs and other supplements that your child takes, and the dose.
  • Questions to ask your child's health care professional that you can make the most of your time together.

Some basic questions to ask may include:

  • What is the cause of my child wet the bed?
  • When can my child outgrow wetting the bed?
  • What treatments are available, and which do you suggest? Are there any side effects?
  • There are other options that the primary approach you're suggesting?
  • Should my child to limit the intake of fluids at certain times?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Feel free to ask questions during your appointment.

What to expect from your doctor

Your child's healthcare provider will likely ask you some questions, such as:

  • There is a family history of bedwetting?
  • Has your child always wet the bed, or did not start recently?
  • How often does your child wet the bed?
  • There are periods of time when your child does not wet the bed?
  • Is your child dry during the day?
  • Is your child having feces accidents?
  • Does your child complains of pain or other symptoms when you urinate?
  • Is your child before any important change in the life or in other situations of stress?
  • If you are separated or divorced, your child housing alternatives in each parent's home? Does the bed-wetting occur in the home?
  • How do you respond to your child wetting the bed?

Be prepared to answer questions, so that you'll have time to talk about what's most important to you.

Symptoms and treatment of nocturnal enuresis