Bed-wetting

Bed-wetting (sometimes called enuresis), is unintentional urination during the night. Most children wet the bed occasionally, and definitions of the age and frequency at which bed-wetting becomes a medical problem vary. Many researchers consider bed-wetting normal until age 6. For a diagnosis of enuresis, wetting must occur twice a week for at least three months with no underlying physiological cause.

Enuresis is divided into two classes. A child with primary enuresis has neverestablished bladder control. A child with secondary enuresis begins to wet after a prolonged dry period. Some children have bladder control problems during both day and night.

The causes of bed-wetting are not entirely known, but it tends to run in families. Most children with primary enuresis have a close relative who also hadthe disorder. Sometimes bed-wetting can be caused by a serious medical problem such as diabetes, sickle-cell anemia, or epilepsy. Snoring and episodes ofinterrupted breathing during sleep (sleep apnea) may contribute to bed-wetting, as do urinary tract infections, severe constipation, or spinal cord injury.

Recent medical research has found that many children who wet the bed may havea deficiency of an important hormone known as antidiuretic hormone (ADH). ADH helps regulate the level of fluids in the body and helps to concentrate urine. Children who wet the bed, therefore, often produce more urine during thehours of sleep than their bladders can hold. If they do not wake up, the bladder releases the urine and the child wets the bed.

Most children who wet the bed do not have physical or psychological problems.Sometimes emotional stress, such as the birth of a sibling, a death in the family, or separation from the family, may be a trigger for bedwetting. Daytime wetting, however, may indicate that the problem has a physical cause. Whilemost children have no long-term problems as a result of bed-wetting, some children may develop psychological problems that are aggravated when playmatestease them.

If a child continues to wet the bed after the age of six, parents may wish toseek evaluation and diagnosis by a pediatrician. The child receives a physical examination, appropriate laboratory tests, including a urine test (urinalysis), and, if necessary other studies.

If the child is healthy and no physical problems are found, which is the case90% of the time, the doctor may not recommend treatment. Instead he may provide the parents and the child with reassurance, information, and advice.

Occasionally a doctor will determine that the problem is serious enough to require treatment. Standard treatments for bed-wetting include bladder training, exercises, motivational therapy, drug therapy, psychotherapy, and diet therapy. A number of drugs are also used to treat bed-wetting. These medicationsare usually fast acting, and children often respond to them within the firstweek of treatment. Among the drugs commonly used are a nasal spray of desmopressin acetate (DDAVP), a substance similar to the hormone ADH, and imipraminehydrochloride, a drug that helps to increase bladder capacity. Studies showthat imipramine is effective for as many as 50% of patients. However, children often wet the bed again after the drug is discontinued, and it has some undesirable side effects.

Some bed-wetting with an underlying physical cause can be treated by surgicalprocedures. These causes include enlarged adenoids that cause sleep apnea, physical defects in the urinary system, or a spinal tumor.

Occasional bed-wetting is not a disease and it does not have a "cure." If thechild has no underlying physical or psychological problem that is causing the bed-wetting, in most cases he or she will outgrow the condition without treatment.

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