Bedwetting: an overview of treatment options

Nutrition Health Review, Summer, 2004 by Howard J. Bennett

Five to seven million children in the United States wet their beds. Although bedwetting is rarely a result of a serious medical disorder, it is difficult to live with. In most cases, a child wets the bed because of a combination of being a deep sleeper and having a small bladder.

Here are some important pointers to keep in mind:

* Children do not wet the bed on purpose, and punishing a child for being wet does not work.

* Since children do not talk about bedwetting outside the family, most of them think that they are the only ones who have the problem. A good way to reassure children is to let them know how many kids wet the bed at school. In an elementary school of 500 children, 50 are wet at night. In a middle school of 1,000 children, 31 are wet at night.

* Children are more likely to overcome their wetting if they are actively involved with a program. Therefore, the child should be motivated to become dry before treatment is begun.

* Before any bedwetting program is started, the child should be seen by his or her doctor to rule out a medical condition as the cause. Constipation, difficulty with urination, and daytime wetting can result in bedwetting.

* The most common medication used to treat bedwetting is DDAVP. This drug helps 50 percent of the children who take it. The effects of DDAVP are not long-lasting, and children often relapse when the drug is stopped. For this reason, doctors usually recommend it for short-term use (i.e., sleepovers, vacations, or special occasions). If DDAVP is prescribed, it is important to restrict the child's fluids after dinner.

* The most effective treatment is the "bedwetting alarm." This small, battery-operated device is worn to bed at night. One part of the alarm attaches to the child's undershirt or pajama top, and the other part attaches to the underpants. When the child urinates, the alarm goes off, creating a loud buzzing sound. The sound is designed to wake the child up and to teach him or her what the bladder feels like when it fills up with urine.

When the alarm first starts to work, children wake up before they wet the bed. Over time, most children actually sleep through the night because their bladders have learned to hold all of their urine until morning. If the alarm does not work, it is usually because it is being used incorrectly. Parents should to follow the manufacturer's instructions and should use the alarm every night. Because children often have difficulty waking up when they first start using the alarm, it helps if a parent sleeps in the child's room to wake him or her up as soon as the alarm starts to buzz.

Acute Bladder Infections Often Mistreated

In recent study of more than 13,000 women, only 37 percent of these patients, who were found to have an acute bladder infection, received the preferred treatment: a combination of the antibiotics trimethoprim/sulfamethoxazole (Bactrim[R]). Almost 32 percent of the women were prescribed fluoroquinolone antibiotics, such as Cipro[R]. The fluoroquinolones are not the first choice for acute bladder infections. The duration of treatment was also longer than the preferred time in many cases.

According to the Centers for Disease Control and Prevention (CDC), part of the U.S. Department of Health and Human Services, nearly 90,000 people die every year from infections they receive in the hospital, and more than 70 percent of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them.

(Source: Centers for Disease Control and Prevention.)

[c]2005 NAFC. This article is reprinted with permission from the National Association For Continence (NAFC). If you would like more information on causes, prevention, diagnosis, treatment, and management alternatives for incontinence, please contact NAFC at 1-800-BLADDER (toll-free) or visit its Web site at www.nafc.org.

(Dr. Bennett is currently writing a self-help book for children and parents on bedwetting.)