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Bedwetting (or nocturnal enuresis or sleepwetting) is involuntary urination while asleep.Most children outgrow it between the ages of 6 and 10. In most cases, bed-wetting is not a disease but rather a normal variation in development. A child who has been dry for several months or longer may start to wet the bed again. This can happen without a clear cause or may be caused by a urinary tract infection or emotional problem.
Last Updated -21st December 2005
Primary enuresis is when the child has never been dry at night or would not sleep dry without being taken to the toilet by another person or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness. Secondary enuresis occurs when a child goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis is often caused by emotional stress.
Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.
- One is a hormone cycle in which a minute burst of an antidiuretic hormone happens daily at about sunset reducing kidney output of urine well into the night so the bladder doesn't get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six, others between six and the end of puberty, and some not at all.
- The other is the ability to awaken before sleepwetting. For some children this is a natural extension of learning to be aware of and control their bladders while awake. For others, a variety of factors suppress or disrupt this awareness when asleep, and they are unlikely to develop it. Taking children to use the toilet while not fully awake can prolong dependence on that by encouraging them to urinate while nearly asleep.
- One prescription drug used to treat bedwetting with much success in older individuals is Imipramine, which is also a very mild antidepressant sometimes used to treat ADD/ADHD.
- Another medication, DDAVP, is a synthetic replacement for the missing burst of antidiuretic hormone. Whether used daily or occasionally, DDAVP simply replaces the hormone for that night with no cumulative effect.
- Some psychologists and experts recommend the use of night-time training devices such as a bedwetting alarm to help condition the child first to wake up at the sensation of moisture and then at the sensation of a full bladder. Success with alarms is increased and relapses reduced when combined in programs which may include bladder muscle exercises, dietary changes, mental imagery, stress reduction, and other supportive activities.
- Do not punish, embarrass or blame your child.
- Have your child empty his or her bladder before going to bed.
- Remind your child to get up during the night to urinate. You may provide a bedside potty chair and night light.
- Do not force your child to wear diapers at night. Try waterproof or extra-absorbent underwear instead.
- A thick pad or a vinyl mattress cover will protect the mattress.
- Encourage your child to take responsibility for changing his or her clothing after wetting.
- Wash underwear and bedding with 1/2 cup vinegar to elimate odor.
When To Call a Physician
- If bed-wetting occurs in a child older than 6 years of age and home treatment is not successful after 4 weeks.
- If bed-wetting becomes more frequent or severe despite home treatment.
- If bed-wetting occurs in a child who had previously been dry for several months.
- If a child over age 4 is having accidental wettings and stool leakage.
- If a child over age 3 has daytime bladder control problems after having been toilet-trained.
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