Nocturnal enuresis is the involuntary release of urine, specifically in children, during the night -- essentially: wetting the bed. And while bedwetting can be extremely frustrating for parents, it’s equally frustrating (and embarrassing) for the child. Here are a few techniques for treating bedwetting without shaming your child.
Consequences of Bedwetting
While most children quit wetting the bed when they get full control of their bladder and a full complement of nervous system sensations (ages 5-7), a small percentage of kids continue to have problems beyond that. This can create feelings of low self-esteem, isolation, ostracization, and shame. One of the most important things to remember when trying to manage bedwetting -- even at 2:00 in the morning from a sound sleep -- is that your child needs patience and support. This isn’t an attempt to punish you, and they don’t enjoy it any more than you do. As slumber parties and camp outs with friends become an option, wetting the bed becomes that much more embarrassing; thus, you have an additional motivator to work with.
Prescription Medications
There are medications that can help tiny, overactive bladders, but these should be reserved for when everything else has failed. Anticholinergic medications are intended to slow down the bladder’s contraction, making it easier to hold more for longer. Additionally, when an anti-diuretic hormone (ADH) imbalance is to blame and the child’s body is not stimulated to make less urine throughout the night, taking desmopressin can help to increase ADH levels. However, there are serious potential side effects and these medications should not be over or needlessly used.
Behavioral Treatments
Moisture alarms have been very successful for some families. A small alarm is attached to a moisture-sensitive pad. The alarm goes off (hypothetically) waking them up as soon as they begin to urinate so they can stop and get to a toilet. For very hard sleepers, it may be necessary to have someone else in the room to ensure they wake up. These can take several weeks to begin being effective and may take months to actually stop bedwetting completely.
Other options to help avoid uncomfortable midnight wakes up include avoiding fluid intake right before bed. Caffeine, in particular, should not be consumed at night -- although it is not recommended for small children at any time of day. Once bedtime arrives, encourage your child to go to the bathroom not just once, but twice before falling asleep -- despite any protests of “not having to go.” If they are afraid of leaving the bedroom to go to the bathroom in the middle of the night, leave night lights to keep the necessary pathways bright. Poor daytime toilet habits can spill over into the night time as well, so help your child go to the bathroom frequently throughout the day.
Treating Underlying Issues
Most importantly, treat any disorders or issues that may be causing the bedwetting. Nocturnal enuresis is often a precursor to diabetes, particularly in tandem with excessive thirst and weight loss. Chronic constipation can wear out the muscles necessary for going to the bathroom; alleviating this inability to “go” can help smooth things out in the long run. If your child experienced several months without bedwetting and has returned to it, schedule an appointment with his/her pediatrician to be sure there is no urinary tract infection or any of the other issues mentioned.
