The medical term for Bed Wetting is enuresis. Bed wetting is not typically treated until 6 years of age because the majority of usual treatments do not work well until then. The majority of normal bed wetter’s are very sound sleepers. This actually turns out to be the cause of the bed wetting. They go into such a deep sleep that the muscles holding the urine back relax and release the urine. If you remember how deep you slept before you had children and how lightly you sleep now, you can see the difference. About 15% of 5 year olds wet the bed, about 2% of 15 year olds, and 1% of adults wet the bed. Between 5 and 15 years of age, roughly 10% of children per year stop wetting the bed. This is an unconscious physiologic action, therefore rewarding or punishing (never to be done) during the day has no effect at all.
To be considered normal bed wetting (primary enuresis), the child should:
- have no issues during the day
- no burning
- no itching
- no feeling of urgently having to urinate
- be able to hold their urine comfortably for 6 or more hours during the day (this demonstrates that they have the volume capacity to hold enough urine through the night, if they can’t hold it that long, then talk to the doctor)
- have never been dry for more than 5-6 months in a row (if they were dry for this long and then started wetting again, this might indicate other issues, talk to the doctor)
Treatment Steps
- Make sure this is just normal bedwetting by reading the paragraph above.
- Fluid Intake: Many recommend to not allow a child to drink after a certain time of day (like 6pm). Your kidneys make urine 24 hours a day at a rate of 1-2 ml per kg per hour. Therefore, a 40# child makes approximately 2/3 to 1.5 ounces of urine an hour. Restricting fluid intake, after a certain time, MIGHT reduce the amount made overnight by a small amount. This might help, IF it’s simply a capacity issue and they wet the bed at the very end of the night. If we restrict clear fluids too much, the urine will become too strong and will cause burning and urgency during the day.
- Change Sleep pattern: Remember that children with bed wetting are very deep sleepers, and going into a very deep sleep is what we think causes the muscles to relax and then they wet the bed. If we screw up their sleep pattern, will hopefully reorganize into a lighter type sleep (like after you had children) and therefore, not cause that muscle to relax.
- STEP 1: Put your child to bed when you normally do, but then wake them up when you go to sleep an hour or two later. You must FULLY wake them up, have them go urinate, and then go back to bed. This might mess up their sleep enough to reorganize into a lighter stage. Give it a few months to work.
- STEP 2: Get a BED WETTING ALARM from either a local home health company (we can write a prescription for it) or online (The Bed Wetting Store or others). Make sure the alarm is loud enough to wake YOU up and that the child can’t lightly awaken and turn it off before you get there. The alarm is not going to wake the child up or teach them anything. It is a pad they sleep on or a device that clips to their underwear. When urine hits the sensor, the alarm goes off and wakes YOU up. You then wake the child up, ABSOLUTELY COMPLETELY AWAKE NOT GROGGY, have them go to the bathroom, help you change the bed and then go back to bed. The way this works is that it wakes YOU up to wake the CHILD up when they are in that deep stage of sleep (as evidenced by the fact they just urinated). When you FULLY wake them up, it messes up their sleep cycle HOPEFULLY into a lighter stage therefore fixing the issue. There is a high success rate after about 2 months. If it does not work in 2 months, then pack it up and try again a few months later. If it works, there is sometimes a relapse after a few weeks, just repeat using it again.
- DDAVP: Is an expensive ($100-250 per bottle) prescription nasal spray and chemically tells your kidney to not produce as much urine for a few hours. From what we just discussed, you can see that this is only a temporary solution for special occasions, such as vacations. DDAVP only results in less urine in the bladder. Insurance may not cover it. It is not 100% effective and has no permanent effect.
- Imipramine: This is a tricyclic antidepressant. No, your child does not have depression. In much lower doses than used for depression, the medicine lightens the state of sleep. As you read earlier, lighter sleep usually means the muscles won’t relax and release urine. This has a fairly high success rate with minimal side effects, but obviously is a last resort. If it works, we usually try to wean off every 4-6 months or so until it is no longer needed. Side effects are minimal.
- Finally, your child can still go on sleep-overs without being treated. Simply send them with a sleeping bag and have the parent get them up earlier than the other kids to clean up.
