Bed-Wetting

Q:  What can you tell us about the problem of bed-wetting?

A:  There are few problems that have the potential to disrupt a parent-child relationship than that of bed-wetting. Night after night of wet bed sheets strains the patience of parents and represents a repetitive source of embarrassment to the child, most often a boy.

Most children are completely continent (that is dry day and night) by the age of 3 to 4, with boys lagging behind girls in achieving this milestone. A very small percentage of those children who wet the bed have a legitimate problem that may be due to a urinary tract infection or an undiscovered defect in their urine elimination system. This is the first consideration and must be completely investigated before proceeding further.

Diabetes may result in an abnormally large urine volume and should also be a part of the investigation.

Many of these children fall into a very deep sleep and simply don't wake up when the signal of a full bladder is sent to their brains. There is often a family history of this, and both parents should inquire of one another's past to determine if this is so.

The reality is that these children will someday become continent at night, and the decision to consider methods to treat becomes a subject of negotiation. For example, sleepovers at a friend's or relative's home may be special considerations.

Methods for treatment may include:

1. Restricting fluid intake before bedtime. (Do not try to awaken children and encourage them to urinate in the middle of the night.)

2. A nasal spray can be used that safely affects kidney function, resulting in reduced urine volume at night.

3. Very low doses of certain antidepressants have beneficial side effects of making the muscle stronger that operates the valve-controlling outflow from the bladder.

4. There are bed alarms that awaken the child when small amounts of urine are sensed, and the child is then able to get up to void.

5. Patience -- use a vinyl or plastic cover for the child's mattress and require the child to help change the bed and wash the sheets on the mornings after bed-wetting has occurred, without becoming angered or exacting punishment. The child is not doing this on purpose, and bed-wetting is not associated with any personality defects or lack of intelligence.

"Your Health" provides easy-to-understand information about common health conditions.