The process by which children learn to stay dry at night is somewhat complicated. The child’s brain must tell the child’s bladder to retain the urine even if the bladder is full. The brain must then awaken the child so that he can go to the bathroom rather than just permit the bladder to release the urine into the bed. It appears that the signal to awaken may not be as strong in children with enuresis as in those who do not have this problem. Often parents describe their child as a "deep sleeper."

Children who have never been consistently dry at night for three consecutive months have primary nocturnal enuresis. Medical causes for primary nocturnal enuresis are uncommon. Children who have been dry and start to wet have secondary nocturnal enuresis. Medical causes are more common in these cases, but still uncommon. If secondary nocturnal enuresis occurs, it should be discussed with the child's doctor. Some non-medical causes can be the stress of a new baby in the family, difficulty in school, or worries about family problems.

Children typically urinate more frequently than every four hours and more than four times a day. Children who are toileting less frequently or who are bothered by constipation (having hard and infrequent bowel movements—less than once every two days) have a higher risk for bedwetting. Constipation contributes to bedwetting because that stool backed up in the intestine can place pressure on the bladder leading to more frequent bedwetting. One of the first steps in helping a child with bedwetting is to help them develop more frequent toileting habits and to resolve the constipation.

When Should You Seek Help?

You take your child to the doctor or nurse practitioner if:

Behavior training usually involves a bedwetting alarm. A sensor is placed in the underwear and attaches to an alarm that sounds when the underwear is wet. Over the course of months, the child learns to wake himself before he wets. About 70 percent of children are cured with this approach, but relapse occurs in about 25 percent. Dry Nite Training® by Fisher Price and WetStop® by Palco are two such alarms. They cost $60 to $80. These alarms have been proven safe over many years and do not have a risk of shocking the child.

Medication can be used to treat bedwetting yet rarely cures the problem. Desmopressin (DDAVP) is an antidiuretic hormone that helps the body to conserve urine so the child produces less urine than normal overnight and is less likely to wet the bed. DDAVP is available in a nose spray or tablet form and is taken just before bed. DDAVP works in one to three days and is ideal for camps and overnights at friends' homes. It is recommended that the child restrict fluid two hours before bedtime and drink extra fluid the next day.

Imipramine, an antidepressant medication, also reduces bedwetting. It probably works by altering the depth of sleep and is taken at bedtime. About half of treated children will show improvement. Some children become drowsy from the medication or have difficulty sleeping or concentrating. In rare cases, Imipramine can cause heart rhythm disturbances. Although once widely used, it has fallen into disfavor.

Both medications result in temporary improvement in many cases, but rarely cure the problem. As soon as the medicine is stopped, the bedwetting often recurs.

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What Can Parents Do?
 

Plainly Speaking
Bedwetting is a common problem that rarely has a medical cause. As the child gets older, almost all children outgrow the problem. If you or your child are concerned about bedwetting, you should contact your physician or nurse practitioner.