Munson Health
 
Bed-wetting

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by Wood D

(Enuresis; Primary Nocturnal Enuresis; PNE)

 

Treatment

Most children will stop bed-wetting by the time they reach puberty. However, bed-wetting can remain a problem for up to 1% of adults.
Most treatment aims to gradually reduce the number of bed-wettings until the child grows out of it. Treatment is rarely appropriate before age 6.
If your child's bed-wetting is caused by an infection or physical abnormality, a treatment plan will be created for that issue. Since this is uncommon, most children may be treated with one or more of these ways:

Motivation and Family Support

Bed-wetting is rarely an intentional act. Children are usually upset and ashamed when it happens. Do not punish the child. It is important that parents offer encouragement. The bed-wetting will stop with time. Do not let siblings tease the child who wets the bed.
Keep careful records of the child's progress. Offer consistent support. A simple motivational method is the use of positive feedback, such as a star chart.
Avoid giving the child anything to drink after 6:00-7:00 PM in the evening. Have your child urinate before going to bed. Sugar and caffeine should also be avoided after late afternoon.

Behavioral Conditioning

A conditioning device may be recommended. One example is a pad with a buzzer that sounds when wet. The pad is worn in the child's underwear. The alarm will wake the child up to use the toilet. Parents may need to help the child get to the bathroom and reset the alarm.
Dry bed training is another type of therapy. With this training, you follow a schedule where you wake your child up during the night to use the bathroom.

Bladder Training

Some doctors suggest bladder-stretching exercises. While awake, the child gradually increases the amount of time between urinations. Do not try this method without talking to the doctor. Holding in urine can lead to daytime wetting and urinary tract infections.

Medication

Medication is rarely given. However, it may be used for short-term situations like a sleepover or vacation. Some medications include:
  • A hormone that decreases the amount of urine that is made
  • An antidepressant that lightens the level of sleep and may also decrease how often your child urinates
  • A medication to reduce bladder overactivity and frequency of nighttime wetting
 

RESOURCES

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

 

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

Alberta Health and Wellness
http://www.health.alberta.ca

 

References


Enuresis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 21, 2014. Accessed September 3, 2014.


Facts for families: bed wetting. American Academy of Child and Adolescent Psychiatry website. Available at: http://www.aacap.org/cs/root/facts%5Ffor%5Ffamilies/bedwetting. Updated December 2011. Accessed September 3, 2014.


Lee T, Suh HJ, et al. Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone, or imipramine alone: a randomized controlled clinical trial. J Urol. 2005;174:1084-1087.


Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009 Apr 2;360(14):1429-1436.


Robson WL, Leung AK, et al. Primary and secondary nocturnal enuresis: similarities in presentation. Pediatrics. 2005 Apr;115(4):956-959.


Waking up dry: Helping your child overcome bedwetting. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Waking-Up-Dry-Helping-Your-Child-Overcome-Bedwetting.aspx. Updated May 9, 2014. Accessed September 3, 2014.


12/13/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 2007 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements: Desmopressin acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray). US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#Desmopressin. 2007 Dec 4.


9/23/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Glazener C, Evans J, Peto RE. Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews. 2004(1). CD004668. DOI: 10.1002/14651858.CD004668.


10/10/2013 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mellon M, Natchey B, Katusic S, et al. Incidence of enuresis and encopresis among children with attention-deficit/hyperactivity disorder in a population-based cohort. Acad Pediatr. 2013 Jul-Aug;13(4):322-327.

 

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