Bedwetting

While it can be a stressful situation for both parents and children, bedwetting is manageable.

Common in younger children just beyond the age where remaining dry at night is generally expected, bedwetting (nocturnal enuresis) is an involuntary loss of bladder control that usually occurs while sleeping. It's a condition that falls into two categories.

• With primary bedwetting, a child hasn't been able to remain consistently dry at night since being potty trained.
• With secondary bedwetting, a child suddenly develops issues with urination at night after having been able to remain dry before.

What Causes Bedwetting?

Once thought to be psychological, bedwetting is now considered to have other causes beyond emotional ones. For instance, some children have a bladder that hasn't yet matured enough to be able to successfully transmit signals to the brain to wake them so they can urinate properly. On a related note, some children have a small bladder that's not able to sufficiently store urine at night.

If children experience frequent urination and daytime "accidents," they may have a urinary tract infection that's contributing to the problem. Additional causes and contributing factors that may be related to bedwetting include:

• A hormone imbalance involving the anti-diuretic hormone (ADH)
• Sleep apnea
• Diabetes
• Chronic constipation

Possible Risks Factors

Affecting anywhere from 5 to 7 million children in the United States, bedwetting has been linked to certain risk factors. While anyone can be affected by the condition, it's more common in boys than girls. In some instances, nocturnal enuresis is triggered by stressful events in a child's life, such as going from kindergarten to first grade or having a new brother or sister. It's possible for bedwetting to run in the family; meaning if one or both parents experienced it when younger, their children are more likely to have the same issue. The problem is also more common in children with ADHD (attention deficit hyperactivity disorder).

How Is Bedwetting Diagnosed?

Generally, children should be at least five years of age and have had a minimum of two occurrences of nocturnal incontinence each month to be evaluated for bedwetting. Diagnosis involves a physical exam, a review of family symptoms, and testing that typically includes urinalysis, a term used to describe a series of urine tests. Image tests may be done to check the bladder, kidneys, and urinary tract.

Treatment Options

Oftentimes, the only treatment that's necessary is regular monitoring until the child outgrows bedwetting. If underlying issues such as a urinary tract infection, sleep apnea, or diabetes are contributing to the problem, treatment will address those specific issues in an effort to minimize or stop nocturnal incontinence. Lifestyle schanges that may include limiting liquids prior to bedtime and avoiding foods/beverages with caffeine are sometimes suggested. Treatment may also involve:

• Moisture alarms to wake children as they begin to urinate
• Anticholinergic drugs to calm the bladder for children with a small bladder
• Medications that slow nighttime urine production

If bedwetting continues even after initial attempts at treatment, a urologist may recommend a more comprehensive evaluation of the urinary system to determine if there are other issues that may be contributing to the problem, such as a structural defect or issues with nerves. Regardless of what may be causing nighttime incontinence, it's important for parents to remain supportive and realize it's something their child cannot control. Oftentimes, it's only a temporary problem.