Author:Dr. P. Siva Bharathi, M.D (Peds), AB (USA).
Introduction: This is a common problem in children and is more common in boys than in girls. Kids become dry during the day by about 4 yrs of age and dry during night by 6-7 yrs of age. Mostly this problem resolves on its own without any treatment but some time this may be a concern for the kids and their parents as it may be embarrassing and inconvenient.
- Some of the causes for bedwetting are
- A small and immature urinary bladder
- Imbalance in hormone: Some kids won’t produce enough hormone that slows down the night time urine production.
- Urinary tract infections
- Deep sleep that prevents the kid from feeling the full bladder.
- Diabetes: Some times this might be the first sign of diabetes
- Genetics: Kids born to parents who had bedwetting during their childhood are more likely to wet their bed during night.
- Constipation: Loading of stool in the rectum reduces bladder capacity and can cause bed-wetting.
- Stress: Stressful events like birth of a sibling can trigger bed-wetting.
Bedwetting becomes a problem for the kid if it interferes with their ability to socialize with their friends. If the parents choose to consult a doctor for this problem, it would be helpful if the parent collect the following information.
Keep a Voiding diary: Note down the number of times your child used toilet in a day (both day and night) and also note down the daily fluid intake.
- Any major stresses in the kid’s life recently.
- List of medications
Tests: Your doctor might check your child’s urine to check for infection or diabetes.
Most children won’t need treatment for bed-wetting, especially if there is family history of bed- wetting and if your child is not much worried or embarrassed.
Remember that bedwetting is completely involuntary and that a child should never be punished for bedwetting.
Lifestyle Modifications: The following are some of the lifestyle changes that parents can try at home initially.
- Fluid management: Limit the fluid intake in the evening time to about 250 ml and avoid all caffeine containing beverages
- Encourage voiding before bed
- Remind every night to get out of bed and use the toilet. Use small night-lights to help your child to find the way to the toilet at night.
- Stop using diapers or pull-ups
- Encourage your child to urinate once every two hours
- Treat constipation
- After a wetting accident, encourage the child to go to bathroom before changing to new cloths
- Encourage the child to help with morning bed clean up
- Make sure the child showers daily to avoid urine odor
- Never tease or punish the child for bedwetting
Motivation: Keep a record of progress and with reward with a gift for longer periods of dryness. This is good method to try for very young kids
Bladder Training: For kids with small bladder capacity, bladder training can be tried. Gradually increase the time between the voiding during the day time, by encouraging the child to hold the urine as long as possible (The idea is to gradually increase the capacity of the bladder)
Moisture Alarms: These are small battery operated devices with a moisture sensitive pad, which can be placed under the child at night. The alarm goes on when the child urinates and helps them recognize bedwetting when it occurs, creating a response of waking up when the child needs to go to the bathroom. Alarms are the most effective method for controlling bedwetting (provided if the child is motivated). It usually takes at least 2-3 weeks to notice any response. Unfortunatlely bedwetting alarms are not widely available in India. You can try buying online from this website.
Medications: This is usually tried as a last resort. The following are some of the medications used.
Desmopressin: This medication helps to slow the nighttime urine production. This is available as pills or nasal spray. However the nasal spray isn’t recommended for treatment of bedwetting. Oxybutynin (Ditropan): This medication helps to increase the bladder capacity. Side effect of this medication are dry mouth and flushing.
Tricyclic antidepressants (Imipramin): This medication- change the sleep-wake pattern and help improve bedwetting. Because of the serious nature of these side effects, this is usually used only if other treatments have failed.