Communication is Key with Bedwetting

Every day, 5 million American children wake up not knowing if their bed
will be wet or dry. Many of these children feel embarrassed and ashamed—and some are punished.
Bedwetting is almost as common as asthma, but it is often not discussed, even with doctors,
because of its embarrassing nature.

A recent study showed a significant communication
breakdown between parents and doctors on this issue. While 82% of parents want healthcare
providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves.
Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at
routine visits.

Bedwetting is rarely caused by a serious medical disorder. In most cases, it
is due to a maturational delay in the way the brain and bladder communicate with each other at
night. There are three main factors that contribute to the problem:

• Bladder
  size—Children who wet the bed usually have a smaller bladder capacity than their peers. This
  causes them to urinate more frequently during the day and their bladder has less room to “hold”
  urine at night.
• Nighttime urine production—The brain produces a hormone at night
  that reduces the amount of urine the kidneys make. Some children who wet the bed produce less of
  this hormone and thereby make more urine while they sleep.
• Difficulty waking up—
  For many years, it was thought that children wet the bed in deep states of sleep. However, recent
  research has shown that children wet the bed in all sleep states. These studies have
  demonstrated that children who wet the bed are unable to arouse from sleep when the bladder
  reaches its maximum capacity.

A fourth factor, which is often overlooked by doctors
and parents alike, is constipation. Because the rectum is right behind the bladder, constipation
can interfere with bladder emptying or the way the bladder signals the brain that a child needs to
go. This can lead to both daytime and nighttime wetting episodes.

There is no magic age when
children are ready to work on becoming dry, however, most children show some concern about the
problem by the time they are 6- to 7-years-old. (Bedwetting is so common that most doctors do
not consider it to be a “problem” until children are at least 6 years of age.)

There are five
signs parents can look for to see if their child is ready to work on becoming dry:

• He
  starts to notice that he is wet in the morning and doesn’t like it.
• He says he does not
  want to wear pull-ups anymore.
• He says he wants to be dry at night.
• He asks if any
  family members wet the bed when they were children.
• He does not want to go on sleepovers
  because he is wet at night.

Whether or not a child is ready to work on becoming dry,
there are a number of steps parents can take to help children feel better about
themselves.

• Do not punish or shame children for being wet at night.
• Remind
  children that bedwetting is no one’s fault.
• Let children know that lots of kids have the
  same problem.
• Let children know if anyone in the family wet the bed growing
  up.
• Maintain a low-key attitude after wetting episodes.
• Praise children for
  success in any of the following areas: waking up at night to rinate, having smaller wet spots or
  having a dry night.
• Encourage children to go on sleepovers. (I devote an entire chapter to
  sleepovers in my book; this chapter can be downloaded from my website for
  free.)

The most effective treatment for bedwetting is a product called the
bedwetting alarm. Most bedwetting alarms are small, battery-operated devices that children wear
to bed at night. One part of the alarm attaches to their undershirt or pajama top and the other
part attaches to their underpants. When the child urinates, the alarm goes off, creating a loud
buzzing sound. The sound is designed to wake the child up and teach him what his bladder feels
like when it fills up with urine. As the alarm begins to work, it teaches children to wake up
before they wet the bed. Over time, most kids stop waking up at night to urinate. This happens
because the bladder learns to hold all of its urine until morning.

There are a few medications
available to treat bedwetting. The one that’s prescribed most often is called desmopressin (brand
name: DDAVP). This drug works by reducing the amount of urine a child makes during the night.
The effects are not long lasting, however, and most children relapse when the medication is
stopped. Consequently, doctors generally recommend it for short-term use such as sleepovers,
vacations or as an adjunct to other behavioral measures.

So why is it that parents and
doctors are not talking to each other about bedwetting? Parents aren’t asking about bedwetting
because they’re either embarrassed about the problem or they aren’t sure the doctor can help.
Doctors aren’t asking about bedwetting because they assume parents would bring it up if it were a
concern. For every child who gives the doctor an indication that something is bothering him, there
are many more who would never say a word. The prescription for this situation is simple: Doctors
need to ask about bedwetting at routine checkups, and parents need to be more proactive by asking
for help if they have a child who is wet at night.

 – Dr. Howard Bennett