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Wake-up call to parents
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Put yourself in his shoes. He’s eight years old and heBedwetting is nothing to be ashamed about. Sometimes it’s a warning sign of serious health conditions. More often it means one hormone in a child hasn’t yet matured – but it will. Until that time help is out there wakes up every morning disappointed to discover he’s done it again, he’s wet the bed. As if that and the discomfort of wet sheets weren’t enough, the parents of this eight-year-old get upset and punish him for it.
By Dr. Anthony Ford-Jones, MB, BS , FRCPC
They tell him that this thing he can’t control is wrong. His parents are so ashamed of his behaviour, they won’t talk about it to anyone, not even his doctor. These attitudes toward bedwetting have prevailed for centuries, but they don’t help anybody. Certainly not a humiliated eight-year-old.
People are beginning to realize that bedwetting is, indeed, out of a child’s control. It in no way implies bad character or deliberate defiance. Bedwetting, otherwise known as enuresis, isn’t caused by emotional disturbance. However, the stress caused by poorly managed bedwetting can cause loss of self-esteem and feelings of inadequacy.
Enuresis is incontinence that only occurs in the night; there aren’t any day-time accidents, and it isn’t accompanied by any incidence of bladder or kidney disease, infection or severe constipation. By age six in boys and age five in girls, most children sleep dry through the night. After that age, about one or two in 10 of the remaining children will become dry each year. About one in 100 continue to wet the bed into early adulthood.
Many falsely believe that bedwetting occurs when a child sleeps too deeply, but many children sleep deeply and don’t wet the bed. That means there must be other factors. In very young children, an immature bladder or “twitchiness” may cause the bladder to empty too easily before it’s full. Failure to wake up in response to a full bladder may be a factor.
The tendency for enuresis to run in the family has led to the search and location of the genes responsible for some cases. It can help children to remind them that another family member had the same problem, making them feel less different.
In the past 20 years or so, science has discovered that a hormone produced by the brain causes urine to be more concentrated during the day and less at night. It’s called the ADH or antidiuretic hormone. Many bed-wetters don’t produce an adequate amount of ADH when they sleep, so drug manufacturers have synthesized a pure copy of the original hormone to supplement production. Children can inhale it as the nasal spray desmopressin or DDAVP. Taken before bed, it reduces nocturnal urine production. Research claims that in about 80 percent of cases, it significantly reduces bedwetting.
What’s the big deal, you may ask. If the problem eventually goes away untreated, why bother treating it? For many, it may not be necessary to treat enuresis, if the child understands he or she is blameless and that the condition will stop in time. In these cases, parents need only cope with the physical reality of a wet bed. They can opt to buy non-disposable bed pads or absorbent underwear. Bed pads go over the sheet and effectively absorb urine, washable in readiness for the next night. They’re less expensive and often preferred by the child over absorbent underwear.
For many children, though, the burden of suffering they carry demands treatment. Many find it hard to accept a condition that prevents them from going on sleep-overs, school outings or camping trips — or makes them have to wear nighttime underwear that looks altogether too much like a diaper, although newer products on the market are trying to address this issue. The fear of discovery for a school-age child is great, and from about age eight or nine, a medical approach usually helps ease their trauma.
Imipramine, a drug in the antidepressant class, has been used in the past with good, if temporary results. There is, however, risk of side effects, and if a toddler accidentally gets into the medicine cabinet and ingests too much, it can lead to tragic consequences. For that reason, it’s becoming more common to turn to the safer nasal spray, when a drug is indicated. A child may only need it for special occasions, like a friend’s sleep-over. Some doctors prescribe it for longer term to try to induce dryness in the child, but this is costly and rare.
A bedwetting alarm is a time-honoured system that helps teach a child to recognize a full bladder and awake in time to pass urine without accident. It works well in most children over the age of eight, but only those motivated enough to allow their parents to waken them when the alarm goes off, as they rarely waken on their own. It may not help very deep sleepers. The alarm costs under $100 and is usually covered by drug insurance. It may take weeks or up to three months to work, but the result is usually permanent.
Many parents are unaware that something can be done to help their bedwetting child, and haven’t thought to ask their doctor about it. Perhaps they believe waiting it out is the best policy. Faced with several options, is that really the best plan?
Sounds good, but gets nowhere
Some of the traditional approaches to dealing with a child who wets the bed may seem like common sense, but they don’t really solve the problem. Parents who get their child up before they go to bed themselves may help curtail accidents, but they don’t bring enuresis to an end any sooner. Cutting back on drinks before bed is rarely helpful, and can cause friction between parent and child. Bladder exercises aren’t the answer, either, and trying to motivate the child with incentives may backfire, since it implies bedwetting is a controllable behaviour. The child can feel like a failure for being unable to achieve the dry bed to win the reward.
Dr. Anthony Ford-Jones, MB, BS, FRCPC, is a pediatrician in private practice in Burlington, Ont.
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