What is bedwetting and why does it occur?
Bedwetting (nocturnal enuresis is the medical term) is defined as wetting the bed at least once a week at an age when the child no longer wears diapers during the day. Statistically, almost 80% of three year olds, 40% of four year olds, 25% of five year olds, 20% of six year olds and 7% of seven year olds will wet their beds consistently at night. That means in a second grade class of 40, there will be roughly three children who wet their beds at night on a regular basis.
Bedwetting is more common in boys than in girls and occurs most commonly in deep sleepers. These children simply miss the cues when their bladder distends and rather than waking up and running to the bathroom, they simply wet their beds. Rarely, it is caused by a urinary tract infection (those kids have daytime wetting and pain).
What can be done for bedwetting?
Under age 7 years, we consider primary nocturnal enuresis or bedwetting (in which the child has never achieved nighttime dryness) normal and recommend using pull-up type diapers during the night. There is no one brand that is better than the rest. Because being dry at night is not under conscious control, it does not pay to test the child and see if he or she can be successful. That approach only leads to frustration and poor self-esteem.
Over time, the child usually outgrows the bedwetting. The frequency will begin to lessen. Once a child is dry for a week, it is then useful to discontinue the pull ups. There is no such thing as a magic moment for nighttime training that if missed, will cause persistent bedwetting. Most parents try waking their child at some point in the middle of the night to see if they can be successful. The deep sleepers stagger over to the toilet and simply cry. Because it is a sleep related disorder, this approach rarely works.
If your child is over the age of 7 years old, we would like to discuss the bedwetting in the office. It may be important to rule out a medical reason first and then discuss options for treatment. One of the natural approaches is to use biofeedback or self-hypnosis to train the body to wake on its own. Although this is not typically a covered service by most insurance companies, it can be very effective. Desmopressin, a synthetic hormone, is an oral medication which has been approved for bedwetting. However, we are reluctant to modify the endocrine system in an attempt to solve this problem and so, this medication is used only as a last resort in patients who would like to attend a sleepover or are going to sleep away camp for the summer.