Bedwetting (Enuresis)

What is enuresis?
Enuresis is a condition in children over the age of 4 who continue to wet the bed. The problem may have always been present or may start up some time after a child is completely potty trained at night.

How common is enuresis?
Enuresis occurs in as many as 15-20% of children at 4 years of age, 5-10% at 10 years and 1-2% at 15 years of age.

When does my child need to see a doctor?
Your child should see a doctor if he/she is 5 years old and still bedwetting. The doctor will take a medical and voiding history, do urine tests and a physical examination. If these tests are all normal, it is unlikely that any further testing will be done.

Does my child need to be treated for this problem?
If the problem is simple bedwetting alone, it is highly likely that the wetting will subside during the childhood years. Enuresis is a very common and almost always a temporary problem. Furthermore, it is not the child¹s fault that he/she wets the bed; it is not because of laziness or the need for attention. Therefore, a positive approach is the best way to handle this problem.

What causes enuresis?

A child with bedwetting may:

• make more urine at night than the bladder can hold
• have a family history (parents and/or siblings who wet the bed)
• be exposed to stress recently such as a move, new school, new sibling, separation, divorce or death
• have a small bladder (and may also wet during the day)

What treatments are available for enuresis?
If your child wets only at night, has never had a urinary tract infection and urinates normally during the day, a physical cause of the wetting is very unlikely. Therefore, he/she may choose no treatment, or may try an enuresis alarm or medication.

No treatment - Some families are relieved to know that their child has no medical problems as a cause of bedwetting, and choose to wait until they grow out of the problem. If there is a family history of the problem, many children will quit wetting at the same age as the other family member did. If the wetting seems to be causing significant distress to the child, some form of treatment may be tried. The first steps to take are (1) discourage drinking of fluids for 2 hours prior to bed, (2) avoid caffeine and (3) make sure your child urinates just before bedtime.

Enuresis alarm - If your child is 7 years old, you may want to try a moisture (enuresis) alarm. Using this alarm may be time-consuming and often requires cooperation and patience of other family members. The purpose of the alarm is to wake the child up at the time that wetting begins. The child must then go to the toilet, empty the bladder completely (if not already empty), reset the alarm and go back to bed. The alarm may work best in children who learn to wake themselves up when the alarm goes off. Eventually (after at least 3 months of use) they may be able to wake up before they start to wet the bed. Some tips for your child on using the alarm:

• test the buzzer before you start
• keep a night light on
• try to beat the buzzer by running to the bathroom as soon as your bladder is full or just after it starts to empty
• put on dry pajamas, cover the wet spot on the bed with a towel and reset the alarm before you go back to bed
• keep a calendar and write DRY, WET or WET SPOT on it each morning; give yourself stars for dry nights
• use the alarm until you are dry every night for 3-4 weeks

As a parent, you can help your child best by making sure he/she wakes up when the alarm goes off but letting him/her take it from there and gradually phasing yourself out of the program as soon as possible.

Where to get enuresis alarms

Nytone Medical Products: 1-800-973-4090
Palco Laboratories:  1-408-476-3151
SleepDry: 1-800-346-7283
Koregon Enterprises: 1-800-544-4240

Some of these companies have a money back guarantee.

Medication

Medications to treat enuresis are effective in only about half of the children who take them and are not cures: once they are stopped the enuresis quickly returns unless the child has outgrown it. These medicines may be given to children age 6 or older.

DDAVP is like a natural hormone that the body makes to reduce the amount of urine made by the kidneys at night. Some children do not produce enough of this hormone at night. It is given by nasal spray but may be available as a pill in the future. We start with 1 spray in one nostril before bedtime and gradually increase to a maximum of 4 (2 sprays in each nostril). If successful, we continue the medicine for 6 months at the lowest effective dose, then gradually stop it and see if the enuresis returns. Another option is to give the medicine only for special occasions, such as sleepovers or camp. Side effects are uncommon but may include headache, nausea, nasal congestion, nosebleeds, abdominal cramps, high blood pressure and low blood levels of sodium.

Tofranil (imipramine) helps enuresis by increasing the amount of urine that the bladder can store. It is given one hour prior to bedtime and the dose may be increased gradually until an effect is seen. If successful, it is continued for 6 months. It is important to gradually stop the medicine over 3-4 weeks because if stopped abruptly, side effects may occur. Possible side effects with this medicine include dry mouth, constipation, dizziness, sleep problems, irregular heart beats, stomach upset or personality changes. It is very important that this medicine be kept out of the reach of children since OVERDOSAGE MAY RESULT IN DEATH.