It sounds like you have tried a lot of different techniques to help your son with his bedwetting (also called nocturnal enuresis). First, I just want to emphasize how common an issue bedwetting is in children, especially males. About 5 percent of children aged 10 to 11 years old will have issues with nocturnal enuresis. There can be a variety of causes, including a small bladder, an immature bladder that does not always empty appropriately, a family history that makes bedwetting more likely, deep sleeping, stress, and increased urine production at night that may be related to abnormal secretion of hormones that affect urine volume. I believe the “heart hormone” that you have heard about is atrial natriuretic peptide, a hormone involved in the body’s fluid regulation that is secreted from the heart. Studies I have read have not supported initial thoughts that children with nocturnal enuresis have abnormal amounts of atrial natriuretic peptide. It is not currently recommended as a treatment for children with primary nocturnal enuresis. Certainly, by the age of 10, I do recommend treatment for those with bedwetting issues because it can be very embarrassing for children this age to attend sleepovers or camp. DDAVP (desmopressin) has been shown to be effective in almost 50 percent of patients who have nocturnal enuresis; however, there is a very high relapse rate when the medication stops. DDAVP works by decreasing the production of urine. It is usually given right before a child goes to bed. It seems that your son has not responded to DDAVP, which is not uncommon! Surprisingly, the most effective treatment for bedwetting is actually “bedwetting alarms,” or underwear that can detect urination. These “alarms” help approximately 70 percent of patients, with a low relapse rate. I would certainly recommend that you try a bedwetting alarm before you try a new medication. Your child’s pediatrician can give you specific instructions about how to best use the alarm to modify bedwetting behavior. If your son is still having significant issues with bedwetting, I would recommend he see a pediatric urologist. Your son’s primary care doctor can be a great resource in helping you develop a plan for your son’s treatment. I would definitely involve him in whatever decisions you make. Q2. My daughter is 7, and she wets her bed about three times a month. Is this normal? What can I do to help? — Maria, New Hampshire Bedwetting is a common childhood problem. The medical term for it is nocturnal enuresis. Most children are toilet trained by the time they are 5 years old, however, approximately 3 percent of girls your daughter’s age will have occasional nocturnal enuresis. If your daughter has no other symptoms, such as an increase in amount, frequency, urge, or pain with urination, and if she has always had difficulty with wetting the bed, she has a benign type of nocturnal enuresis. The exact cause of this type of nocturnal enuresis is not known. It can be embarrassing and cause anxiety for both children and parents, especially as children get older and want to have or attend sleepovers. Nocturnal enuresis does seem to run in families. It may be due to deep sleep, a small bladder, delayed control of the urination system, or some psychological component. Although diapers may seem like a tempting solution, it’s important that your daughter learns how to better control the problem. There are several strategies you can try to help reduce the frequency of these episodes. I recommend starting with a conversation to explain nocturnal enuresis to your daughter, so that she understands what is occurring and does not feel guilty or unusual for having this issue. There are good handouts on the topic that can help you with this discussion. Other things you may want to try include:
Limiting your daughter’s food and fluid intake close to bedtime (but not during the rest of the day).Completely removing any caffeinated beverages like iced teas or sodas from her diet.Developing a routine in which your daughter uses the bathroom right before she goes to sleep to fully empty her bladder.You or your daughter can keep a diary to try to track her bedwetting improvements.Have her help clean up if she has an accident, however, do not treat this as a punishment! Praise both dry nights and thorough cleaning up of accidents. Avoid criticism and teasing by other family members!
These simple measures help to improve symptoms in most patients, although only about a quarter of patients are “cured” by these measures. If your daughter continues to have nocturnal enuresis, there are other options, such as special “bedwetting alarms” or underwear that can detect urination, hypnotherapy, and medications. Rarely, bedwetting may be caused by a urinary tract infection or can be a sign of a more significant issue. This is unlikely if the problem only occurs at night and on an occasional basis. A number of behavioral and medical treatments exist for benign nocturnal enuresis that does not get better on its own, or by using the simple measures mentioned above. Consult your child’s pediatrician if your daughter is having any other symptoms associated with her nocturnal enuresis or for more details about treatment options. Learn more in the Everyday Health Kids’ Health Center.
