November 30, 2015
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Bedwetting (cont.)

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What is the basic problem in primary bedwetting?

The fundamental problem for children with primary bedwetting is the inability to recognize messages of the nervous system sent by the full bladder to the sleep arousal centers of the brain while asleep. In addition, bladder capacity is often smaller in bedwetting children than in their peers.

What is the cause of primary bedwetting?

Parents sometimes believe that their child's primary bedwetting is emotional. No medical or scientific literature exists to support this impression. There is evidence, however, that children with "sleep disordered breathing" (ranging from snoring to sleep apnea) are at an increased risk for developing primary bedwetting. There are some studies that suggest that some children with symptomatic adenotonsillar hypertrophy and bedwetting may benefit from surgical removal of tonsils and adenoids (adenotonsillectomy) as a treatment. But more research is needed in this area.

What is the treatment for primary bedwetting?

The "cure" for primary bedwetting is "tincture (or passage) of time." However, since many parents and children are frustrated with bedwetting as it starts to interfere with self-esteem or social events (for examples, sleepovers, camp attendance, etc.) a patient step-by-step approach is best. Fortunately, the treatments are more often successful than not. One should always discuss treatment options with a child's physician, since it is important to differentiate between primary and secondary enuresis prior to starting specific treatments.

It is also important to remember that different children develop at different rates and that primary enuresis can be a normal developmental stage. Toilet training a child requires special patience. While most children are fully toilet trained by 3-4 years of age, many will not stay dry overnight, even though they can during the day. Reassurance and encouragement often will work in time, but for some children, there are steps that can be taken to address the issues.

Some common recommended management and treatment options include the following:

  1. Encourage voiding prior to bedtime, and restrict fluid intake before bed.
  2. Cover the mattress with plastic.
  3. Bedwetting alarms: There are generally reserved for older school-age children. There are commercial alarms that are available at most pharmacies. When the device senses urine, it alarms and wakes up the child so he/she can use the toilet. The cure rate is variable.
  4. Bladder-stretching exercises are aimed at increasing the bladder volume and increasing the periods between daytime urinations.
  5. Medications, such as desmopressin acetate or antidiuretic hormone (DDAVP) and imipramine (Tofranil), have been shown to be very effective and are used to temporarily treat the nighttime urination, but they do not "cure" the enuresis. Many pediatricians will prescribe one of these medications, especially if the child is engaged in behavioral conditioning as well. Medications are very helpful when a child is not sleeping at home (camp or sleepovers), since the trauma of bedwetting in those settings is predictable.
Medically Reviewed by a Doctor on 7/21/2015


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