DEAR DR. GOTT: My son is 12 years old and had never wet the bed until recently. Now, all of a sudden, he has wet the bed for the past seven nights in a row. We have taken him to see a doctor, but thus far they have taken a urine sample that came back normal.
DEAR READER: Bedwetting, also known as nighttime incontinence or nocturnal enuresis, is common in children up to age 6 or 7. This is because bladder control may not be fully established, meaning the bladder may not signal that it is full, causing the child not to know that he or she needs to urinate.
Most children outgrow bedwetting on their own. By age 5, 15 percent of children wet the bed, and this is further reduced to less than 5 percent of children between ages 8 and 11. It affects boy more than girls. ADHD and a family history of bedwetting increase the child’s risk.
Most cases of bedwetting are simply due to a slow development of the central nervous system. It may also be the result of a small bladder, a hormone imbalance, urinary-tract infection, diabetes, sleep apnea, chronic constipation, stress or a defect in the neurological or urinary system. It is never the result of the child being too lazy to get out of bed at night or being unclean.
Because your son is 12 and didn’t previously wet the bed on a regular basis, his pediatrician or a pediatric urologist should examine him to determine whether there is an underlying reason. You said your son had a urine sample taken but don’t mention what he was tested for. There are different types of urine tests with the most basic done in office with the aid of a small testing strip to determine if there are abnormal levels of protein, white blood cells, etc. This test is insufficient at detecting an infection; therefore, he should undergo a clean-catch urine test, which will then be sent to a laboratory to check for bacteria. If present, the lab will then determine which antibiotic will be most effective in eliminating the infection.
It will also be important to notify the physician of any other symptoms he may be having, even if they seem to be unrelated. For example, snoring may be a sign of sleep apnea, which can cause difficulty waking up, resulting in possible bedwetting should the urge occur at night. You should also be prepared for the physicians to rule out sexual abuse, because sudden-onset bedwetting can be a sign in children and teens.
Treatment isn’t necessary in most cases but varies depending on the cause in those instances when it is. It is most important to be calm and understanding with the child, because there is no control of the occurrence that can lead to embarrassment, anxiety and frustration.
Moisture alarms are small, battery-operated devices available at most pharmacies that connect to a moisture-sensitive pad on the child’s bed or pajamas and go off in the presence of moisture. This may help a child wake up in time to stop the flow of urine and get to a toilet before completely emptying the bladder in bed. If the child is a heavy sleeper, he or she may not hear the alarm, nor wake up in the presence of wetness, so a parent should listen in order to get the child awake and cleaned up before any prolonged contact that can lead to skin irritation. Over time, the brain and bladder will begin to retrain to recognize the urgency and awaken the child before an accident can occur. This can take up to 12 weeks, so it is important to be patient.
Treating any underlying cause should also be beneficial in reducing or eliminating bedwetting.
If time and retraining don’t help, medication may help. Desmopressin acetate (DDAVP) can boost natural levels of antidiuretic hormone (ADH), which slows nighttime urine production. It does carry the serious side effect of seizures so it’s not prescribed for minor cases of bedwetting if other remedies are appropriate. Another medication is a class of drugs known as anticholinergics, which calm the bladder and are often prescribed to treat overactive bladder. A final option is imipramine, which may change the child’s sleep/waking pattern and increase the amount of time that urine can be held or reduce the amount of urine produced. Because it is an antidepressant, it may adversely affect mood and overdose can be fatal, so caution must be used.
Home remedies include avoiding caffeinated foods and beverages in the evening, limiting all fluid intake at night, urinating on a schedule during the day and double voiding before bed (once at the start of the bedtime routine and again just before falling asleep).
It may also be helpful to set up a routine for times when there are bedwetting accidents. This includes using plastic covers over the mattress (under the sheets), using thick, absorbent underwear to reduce urine leakage onto the bedding, and keeping an extra set of pajamas and bedding nearby for quick change.
