>> The most important thing for children to understand about bedwetting is that they are
not alone.
As you can see from the chart, 15 percent of 6-year-olds still wet the bed each night
and even 2 percent of 15-year-olds continue to wet.
Children always want to know, "When am I gonna be dry overnight?"
Every year, 15 percent of kids will become dry on their own without any intervention.
We just do not know when that magical time will occur for each individual child.
So, it is our job to help children become dry before they do so on their own.
Why does bedwetting happen?
As you can see from the graph, there are many factors that contribute to nighttime wetting.
The amount of urine that is made overnight by the kidneys may be more than the bladder
can hold itself.
The biggest reason has to do with the sleep cycle with children who wet overnight.
These kids are sound sleepers who do not wake up to alarm clocks, thunderstorms, or smoke
detectors.
It makes sense that they wouldn't wake up to the sensation of a full bladder during
the middle of the night.
During an office visit for nighttime wetting, there is a lot of important information that
we obtain, including family history of nighttime wetting, sleep pattern of your child, whether
or not they are a heavy sleeper, whether or not there is snoring or sleep apnea associated
with it.
Even though your child may wet overnight, what occurs during the daytime can impact
whether or not a child has a dry or wet night.
A thorough daytime history is obtained.
It is important for us to know how often your child urinates during the day.
Do they even go at school, or do they wait until the last minute to use the restroom?
We additionally want to know if there is any wetting going on during the daytime, even
if it's simple dampness.
A bowel history is additionally asked.
We ask the children how often are they having a bowel movement.
Is there any signs of constipation, including: large stools, painful-to-pass stools, or hard
pebbly stools?
We know that constipation can impact the amount of urine your bladder is able to store, and
it is our goal for these kids to have a soft, daily bowel movement.
A detailed history of your child's fluid intake is obtained, specifically, what and when they
are drinking.
Many children consume a very small amount of fluid during the school day and tend to
fluid overload when they get home from school.
Additionally, we ask whether or not fluids are limited before bedtime.
To begin getting ready for dry nights, it is important that daytime habits are perfect.
This includes making sure that your child is urinating every two to three hours during
the day, with or without an urge to go.
We stress the importance of using the restroom at school.
We ask that children double void prior tobed.
For example, if they generally go to bed at 9 o'clock, we ask that they empty their bladder
at 8 o'clock and then 9 o'clock, right before they crawl underneath the covers.
We ask that bowel movements are monitored to ensure that they are having an easy-to-pass,
soft daily bowel movement.
If this is not happening, we do recommend a stool softener.
We discuss fluid modulation, meaning drinking more of the fluids earlier in the day, and
then limiting fluids two hours before bedtime.
Water is the best choice over juice, sports drinks or soda.
We encourage one glass of water with breakfast, one at lunch, and one after school.
Once the daytime habits are mastered, treatment options for nighttime wetting fall under two
categories: medication or a moisture sensing alarm.
The moisture sensing alarm is a device that the child wears during sleep.
This is an excellent option for children as it is curative.
The moisture sensing device is attached to the underwear with an alarm that is fastened to
their PJs.
Once the child begins to urinate, the moisture sensor causes the alarm to activate.
Eventually, over time, this mechanism conditions the child to wake up to the signal of a full
bladder.
There are several companies that manufacturer bed wetting alarms.
It is important to make sure that you purchase an alarm that does sound and does not simply
vibrate.
The second set of treatment options include medication.
The first is DDAVP or Desmopressin.
DDAVP is a synthetic hormone that is meant to concentrate the urine that is produced
overnight, so your child can store a smaller volume of urine without having an accident.
DDAVP works in about 50 percent of patients.
It is important to understand that DDAVP is simply a Band-Aid to cover up the problem
of nighttime wetting until the child outgrows it on their own.
DDAVP does not need to be taken each night to be effective, and some children choose
to use the medication for social situations, such as sleepovers or summer camps.
It is ordered as a .2 milligram tablet with a maximum dose of three tablets before bed.
It is initially trial and error to decide what dose keeps the child dry, whether it
is simply one tablet or the maximum of three.
If DDAVP is effective for your child, every three months, we do attempt to wean them off
the medication to see if they are able to stay dry on their own.
There are other alternative medications that can be prescribed if DDAVP alone does not
keep a child dry overnight.
Included in those are Ditropan® or Detrol®, which help an overactive bladder or a child
who has a reduced bladder capacity.
At times, the combination of both DDAVP along with the Ditropan or Detrol can keep a child
dry overnight.
The last category of medication is Imipramine, which is a tricyclic antidepressant and is
used cautiously.
In summary, it is important for children to know that they are not alone in bedwetting.
It is an extremely common problem, but one that most children do not want to discuss.
We will do everything possible to help your child stay dry overnight.