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Bedwetting Misunderstood but Often Treatable

Parents Often in the Dark About Why Kids Wet the Bed and What They Can Do

By Jennifer Warner
WebMD Health News

Reviewed by Hansa D. Bhargava, MD

April 23, 2012 -- Researchers are getting closer to uncovering why children wet the bed and what can be done, but many parents are still in the dark.

A new report highlights misconceptions about bedwetting as well as progress in finding out the cause behind the often-embarrassing and traumatic childhood condition, but the report also lists what may be the best help for bedwetting (Hint: Don't be alarmed).

"The mechanisms behind bedwetting are beginning to be questioned," says researcher Darcie Kiddoo, MD, associate professor of pediatric urology at the University of Alberta in Edmonton, Canada. "It is not as straightforward as people once thought."

Kiddoo says the biggest myth about bedwetting among parents is that it is something children can control.

"Kids are not able to control it," Kiddoo tells WebMD. "There is something else going on. We want to make sure we're not making children feel bad or looking at reward mechanisms to try and treat it."

The report shows bedwetting is common among children, affecting about 6% of boys and 3% of girls in the U.S. between the ages of 8 and 11.

Why Kids Wet the Bed

Kiddoo says bedwetting becomes an issue that needs to be discussed with a health care provider when it begins to affect a child's life, regardless of age. For example, when it is causing anxiety or forcing them to miss out on activities like sleepovers that are important to them.

The first step in determining the cause of bedwetting, researchers say, is to look at what is going on with the child during the day.

Children who wet the bed because they have overactive bladders will usually have daytime symptoms like urgency, frequency, and incontinence. Bladder dysfunction can be caused by hormonal imbalances and may sometimes require medical treatment. However the majority of bedwetters do not need medication.

Another cause may be a sleep disorder that is making it harder for them to wake up in response to bladder sensations.

Gender and genetics also play a role in bedwetting. A recent U.S. study showed boys are more than twice as likely as girls to wet the bed. Another showed the odds of children wetting the bed were more than 3.5 times higher if their mother also wet the bed.

Finally, stress and major life events like a new baby in the house, a recent move, or the loss of a loved one have been linked to temporary bedwetting, especially in children who were previously dry during the night. For most bedwetters, though, there are no major life events preceding the issue.

Hidden Cause of Bedwetting

A physical exam, including checking for constipation, is often the next step in determining the cause of bedwetting.

Pediatric urologist Steve J. Hodge, MD, of Wake Forest University says constipation is one of the most common causes of bedwetting in children, but it is often overlooked or misunderstood.

"It's a subtle thing and people often dismiss it," Hodge tells WebMD. "But it is not just simple constipation; it can also mean rectal tone and is often missed."

Hodge says many parents mistakenly think constipation in children only means rare or hard bowel movements. Instead, he says the most common symptom is abnormally large bowel movements.

Excess stool in the large intestine can put pressure on the bladder and reduce its ability to hold urine, leading to bedwetting. An ultrasound or X-ray can reveal stool in the rectum, and treatment with laxatives or enema usually resolves the issue.

Hodge recently published a study in Urology that showed four out of five children who wet the bed showed signs of constipation in X-rays, even though only 1 in 10 had constipation symptoms. Once the children were treated with laxatives or enemas, 83% no longer wet the bed within three months of treatment.

Treatments to Stop Bedwetting

Once the cause of bedwetting is identified, Kiddoo says the most critical aspect of treatment is reassurance for both the parent and the child.

"If it is just nighttime bedwetting, it is not medically serious," says Kiddoo. "But parents should also be aware of the impact on kids. We don't want to minimize how it's impacting their quality of life."

Treatments for bedwetting include:

  • Bed alarms. The report shows alarms that sound or vibrate at the first sign of moisture are the only treatment that has been shown to have a lasting effect on bedwetting. A recent study showed 66% of children who used a bed alarm were dry for 14 consecutive nights compared with 4% of children who had no treatment. These effects persisted after the alarm was stopped.
  • Lifestyle modification. Drinking less at bedtime, reducing caffeine, and having incentives such as rewards may help.
  • Medication. The drug desmopressin may help children who wet the bed due to overproduction of urine, but the effects stop when the medication is discontinued. Tricyclic antidepressants, an older form of antidepressants, may also be helpful to some children, especially teenagers who are also experiencing depression. But these drugs can also have unwanted side effects.
  • Alternative therapies. Hypnotherapy, acupuncture, chiropractic treatment, and psychotherapy have been tried for bedwetting, but researchers say there is little evidence to support these treatments.
  • Taking no action. Bedwetting is a common condition and there is a natural cure rate as a child matures: 15% of children per year will stop bedwetting with no treatment.

SOURCES: Kiddoo, D. Canadian Medical Association Journal, April 23, 2012. News release, Canadian Medical Association Journal. Darcie Kiddoo, MD, associate professor of pediatric surgery and urology, University of Alberta. Steve J. Hodge, MD, assistant professor of urology, Wake Forest University. WebMD Health News: "Study: Constipation May Cause Bed-wetting. "WebMD Medical Reference from Healthwise: "Bed-Wetting - Treatment Overview."

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