BEDWETTING

 

Bedwetting can be a source of great anxiety and lead to feelings of guilt and low self-esteem in a child.

Bedwetting, or nocturnal enuresis, is involuntary nighttime urination beyond the accepted age of control, usually 4 to 6 years. 

 

       - By age five..........85 percent of children are dry at night.

       - By age six...........90 percent of children are dry at night.

       - By age twelve.....97 percent of children are dry at night.

       - By age fifteen.....99 percent of children are dry at night.

 

Bedwetting does run in families: when both parents have a history of bedwetting, three out of four of their children are bedwetters. Bedwetting is a symptom, not a disease; no single explanation can account for all cases.  There is no evidence that an underlying psychological disorder is present in the majority of bedwetters. Still, a number of theories have been proposed to explain the phenomenon. Until recently,the most popular theory was "maturational delay" of the nervous system supplying the bladder.  The most recent theory, and the one gaining wider acceptance, is that bedwetters have an insufficient nighttime rise of an anti-diuretic hormone (ADH), whose role is to concentrate nighttime urine and thereby decrease the amount of urine produced.  Bedwetting should be evaluated by either a pediatrician or a pediatric urologist.  This evaluation is especially important if other symptoms, such as daytime wetting, or an abnormal bowel pattern are
present.

 

Most physicians would not recommend treatment before the child is five years old. If the only symptom is bedwetting, the physical examination is normal, and no history of urinary infection exists,then no other tests are necessary. The decision to treat, however, depends not only on the age of the child but also on the desire of the parents. Treatment may involve behavior modification or daily medication. Behavior modification consists of an alarm device worn on pajamas and activated to awaken the child when he or she begins to urinate. The child learns to inhibit urination. Seventy percent of patients using this technique can be expected to be dry in four to six months. The latest medication is given as a nasal spray called DDAVP. This works by  replacing the insufficient nighttime rise in ADH to allow normal reduction in the amount of urine while the child sleeps. This medication has worked almost immediately in 80-85% of children

             

Key Points:

Discourage nighttime drinking (the more you drink, the more you urinate)

Encourage the child to urinate at night or just before bedtime.

Never punish the child for his accidents.  

Positive reinforcement or reward system always helps

 

Call Office If the following occurs:

- Daytime wetting

- Pain upon urination

- Blood in the urine (red colored urine)

- Narrow pinpoint or deflected urine stream is noted