Enuresis

Introduction
What causes bed-wetting?
When do most children achieve bladder control?
How can my family doctor help?
What are the treatments for bed-wetting?
What kinds of medicines are used to treat bed-wetting?
How can I help my child not feel so bad about wetting the bed?
Skin Rashes Due to Bed-wetting
Directions for Your Child When Using a Bed-Wetting Alarm

Enuresis is the medical term for bed-wetting during sleep. Bed-wetting is fairly common. About 5 million to 7 million children wet the bed. It's more common among boys than girls.

Some of the causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Slower than normal development of the central nervous system--this reduces the child's ability to stop the bladder from emptying at night
• Hormonal factors (not enough antidiuretic hormone--this hormone reduces the amount of urine made by the kidneys)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• Inability to hold urine for a long time because of small bladder

Bed-wetting isn't caused by drinking too much before bedtime. It's not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom. And children do not wet the bed on purpose or to irritate their parents.

Children achieve bladder control at different ages. By the age of 5 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 5 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 5 is not necessary and may even be harmful to the child.

First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis). Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

The doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will ask about your family life, because treatment may depend on changes at home.

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:

• An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
• A reward system for dry nights.
• Asking your child to change the bed sheets when he or she wets.
• Bladder training: having your child practice holding his or her urine for longer and longer times.

Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy hasn't worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects.

Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty about something he or she can't control. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Rashes on the bottom and genital area are a problem for some children who wet the bed. The kidney makes urine by mixing unwanted chemicals with water. When the urine is concentrated and exposed to the skin for a long time, these chemicals can be irritating.

Skin rashes develop more often in children who wear absorbent underpants that contain the urine. The rash is usually most pronounced around the waste or leg bands where the concentrated nighttime urine pools. Early signs of irritation are redness. If the problem continues for weeks, the skin thickens and dries with a flaky appearance. When the problem continues for months and years, the skin might eventually become a paler color or wrinkled.

The best approach is to prevent the rash by treating the bedwetting. Until this is successful there are several ways to minimize the possibility of a rash. Thoroughly rinse the bottom and genital area every morning after waking. Use the correct size absorbent underpant that absorbs the most urine and minimizes the pressure around the waist and leg band areas. Each night before bed, spread a petroleum ointment over the skin area exposed to urine. If this is not enough, ask your doctor for a special mediated cream.

Sometimes the skin rash feels uncomfortable against clothes, and in the presence of sweat, the rash can itch. Some children scratch at the rash and this can lead to a bacterial infection on top of the chemical irritation. When this happens, the rash looks wet and pussy and an anti-bacterial cream might be necessary.

Yeast is a common skin organism that will easily grow on irritated wet skin. When yeast becomes a problem the rash is often a brighter red and little spots spread out from the main area of the rash. Yeast rashes can be treated with a special anti-yeast cream.

A skin rash does not mean that an absorbent underpant cannot be used. Most rashes can be prevented if promptly treated even though a child continues to wear absorbent underpants. For many children absorbent underpants are a good idea; the child is usually more comfortable compared to sleeping and waking up in a cold urine-soaked bed, odor problems are much less, and the sheets, pillows and mattress are protected. However, absorbent underpants are not for everyone. Absorbent underpants should only be used with the approval of the child and should never be forced on a child or otherwise used in a fashion that the child might interpret as a punishment.

1. Remind your child that his or her alarm can help cure bed-wetting when used properly. The main purpose of the bed-wetting alarm is the help your child get up or sleep through without wetting during the night and urinate in the toilet rather than wetting the bed. Emphasize to your child that the alarm will not work unless she or he listens for it carefully and responds to it quickly.

2. Enable your child to help with setting up the bed wetting alarm. Have your child activate the alarm by touching the moisture sensors with a wet finger and practice going to the bathroom as if it were night time.

3. Provide a strong night light or flashlight near the bed so your child can quickly and easily move to the bathroom and urinate into the toilet.

4. Teach your child to go through a self-awakening exercise at bedtime. Encourage your child to "beat the buzzer" by waking up when he or she feels the urge to urinate but before any urine leaks out. If the buzzer does go off, your child should be taught to wake-up, get out of the bed, go to the bathroom and urinate into the toilet.

5. Your child should shut off the buzzer.

6. When the bed wetting alarm has been turned off, and your child has attended to to the bathroom, then your child should put on dry underwear or pajamas, reconnect the alarm, and place a dry pad or towel over the wet spot.

7. Most children do not wake-up to the bed wetting alarm initially and will need your help. You should try going to your child's room as quickly as you can and assist your child in waking up. You may also need to assist your child safely to the bathroom to void.

8. Remember that the goal of the bedwetting bed wetting alarm is to teach your child to awaken before the buzzer goes off or to sleep through the night and remain dry.

9. Instruct your child to go to bed with the radio or television off and go to bed at a reasonable hour. A bright night light may help your child respond more effectively to a bedwetting alarm.

10. The alarm should be used every night until he or she can go 3-4 weeks without a bedwetting episode. This usually takes 2-3 months, so you should be persistent and patient as your child masters nighttime bladder control.

11. When your child awakens the next morning, have him or her write on a calendar "dry" (meaning slept through the night), "Dry woke-up without alarm", "wet spot" (she or he got up after the alarm went off) or wet (he or she did not get up).