Bed-wetting

Encyclopedia of Medicine, Apr 06, 2001 by Genevieve Slomski

If a child continues to wet the bed after the age of six, parents may feel the need to seek evaluation and diagnosis by the family doctor or a children's specialist (pediatrician). Typically, before the doctor can make a diagnosis, a thorough medical history is obtained. Then the child receives a physical examination, appropriate laboratory tests, including a urine test (urinalysis), and, if necessary, radiologic studies (such as x rays).

If the child is healthy and no physical problem is found, which is the case 90% of the time, the doctor may not recommend treatment but rather may provide the parents and the child with reassurance, information, and advice.

Occasionally a doctor will determine that the problem is serious enough to require treatment. Standard treatments for bed-wetting include bladder training exercises, motivational therapy, drug therapy, psychotherapy, and diet therapy.

Bladder training exercises are based on the theory that those who wet the bed have small functional bladder capacity. Children are told to drink a large quantity of water and to try to prolong the periods between urinations. These exercises are designed to increase bladder capacity but are only successful in resolving bed-wetting in a small number of patients.

In motivational therapy, parents attempt to encourage the child to combat bed-wetting, but the child must want to achieve success. Positive reinforcement, such as praise or rewards for staying dry, can help improve self-image and resolve the condition. Punishment for "wet" nights will hamper the child's self-esteem and compound the problem.

The following motivational techniques are commonly used:

• Behavior modification. This method of therapy is aimed at helping children take responsibility for their nighttime bladder control by teaching new behaviors. For example, children are taught to use the bathroom before bedtime and to avoid drinking fluids after dinner. While behavior modification generally produces good results, it is long-term treatment.
• Alarms. This form of therapy uses a sensor placed in the child's pajamas or in a bed pad. This sensor triggers an alarm that wakes the child at the first sign of wetness. If the child is awakened, he or she can then go to the bathroom and finish urinating. The intention is to condition a response to awaken when the bladder is full. Bed-wetting alarms require the motivation of both parents and children. They are considered the most effective form of treatment now available.

A number of drugs are also used to treat bed-wetting. These medications are usually fast acting; children often respond to them within the first week of treatment. Among the drugs commonly used are a nasal spray of desmopressin acetate (DDAVP), a substance similar to the hormone that helps regulate urine production; and imipramine hydrochloride, a drug that helps to increase bladder capacity. Studies show that imipramine is effective for as many as 50% of patients. However, children often wet the bed again after the drug is discontinued, and it has some side effects. Some bed-wetting with an underlying physical cause can be treated by surgical procedures. These causes include enlarged adenoids that cause sleep apnea, physical defects in the urinary system, or a spinal tumor.