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Bed-wetting

Known medically as nocturnal enuresis, this is the inability of a child to control urinating at night. Some children do not attain nighttime control for several years after they have been completely potty trained during the day. In fact, bed-wetting is not considered abnormal until after age five, and even then the situation eventually improves on its own.

Bed-wetting occurs in 15 to 20 percent of all five-year-old children, for an estimated 5 to 6 million children. About 15 percent of these problems will fade away on their own in each subsequent year, so that only 1 to 2 percent of adolescents by age 15 still wet at night. Moreover, 20 percent of children with this problem have some element of daytime wetting.

Cause

Bed-wetting is not a behavioral problem, nor is it related to how a child sleeps. Instead, bed-wetting is caused by a developmental delay in the normal process of achieving control at night. Normally, a hormone called vasopressin is released that prompts the kidneys to slow down production of urine during sleep. Many children who have a problem with staying dry at night do not secrete enough of this hormone. Researchers also have discovered some genetic links that suggest heredity may play a role.

Diagnosis

Any child over age five who is still wetting the bed should be examined by a pediatric urologist to ensure that there are no other underlying problems that may be causing the problem, such as bladder instability or posterior urethral valves. Because between 18 and 39 percent of children have symptoms of bladder instability, a careful history of the child’s complete urinating and bowel habits will be important.

Other studies may include an X ray that examines the urinary tract, called a voiding cystourethrogram (VCUG), a renal bladder ultrasound, or a urodynamics study to assess how the bladder and urethral sphincter function in accordance with the brain and spinal cord during the stages of bladder filling and emptying.

Treatment

Because there are several theories about what causes bed-wetting, there are a variety of treatments based on the premise of each of these theories. There is not one proven theory or treatment that is successful all the time. Often a combination of treatments are needed to control the problem. On the other hand, bed-wetting will eventually stop on its own without specific treatment. Bedwetting is not harmful to a child in any way other than its impact on self-esteem. A child who is embarrassed to attend camp or a sleepover may benefit from treatment that includes restricting fluids after 6 P.M., conditioning therapy using a bed-wetting alarm, drug therapy to replace vasopressin, or psychotherapy.

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