Bed Wetting Information

Home >> Health >> Bed Wetting

Bed Wetting

Gaining consistent control ofbladder and bowel during daytime hours is a significantmilestone for a toddler or preschooler. For many chil-dren, keeping the bed dry at night is a more elusive goal,one that might not be reached until quite a bit later inlife. Children who still wet the bed at night well intotheir grade-school years too often take an emotionalbeating in some cases, a physical beating) because ofthis problem - which is not under their conscious control.One of the greatest problems faced by bed-wetting children is a parent with unrealistic expectations that everychild should be completely dry, day and night, by the ageof three. To deal with bed-wetting effectively and sup-portively, it is important to understand some basic realies of nighttime bladder function in children.

Bedwetting Definition

Enuresis is the involuntary passage of urine into the bedor clothes at least once or twice per month in a child whois at least five years of age.

A child with primary enuresis has never containedconsistently dry through the night for more than six totwelve months. A child with secondary enuresis hasachieved consistent nighttime bladder control for six totwelve months and then for some reason lost it.

Bedwetting Causes

Only about 1 percent of children with enuresis will befound upon medical examination to have an underlyingdisease or disorder such as a urinary tract infection, dia-betes, significant constipation, a congenital abnormalityof the urinary tract, or a disturbance in the central ner-vous system. When evaluating persistent bed-wetting, achild's physician will consider these physical possibilities(which usually have other manifestations) and carry outappropriate studies if necessary.

In the other 99 percent of children with enuresis, theproblem may involve one or more of the following.(Clinicians are not in complete agreement about the rel-ative importance of each of these factors.)

•Delayed maturation. During infancy, the bladderautomatically empties six to eight times per daywhen a certain volume of urine is present. As achild matures, this emptying reflex is inhibited(held in check) by the central nervous system, sothat he can hold larger amounts of urine andeventually release it voluntarily. In general, controlis achieved earlier by girls than by boys. By the ageof three, most children can consistently postponeurinating during waking hours. However, theability of a child's central nervous system toinhibit emptying of the bladder during sleep maylag behind daytime control by months or evenyears. By the age of five, as many as 10 to 15percent of children are not consistently dry in themorning.

•Small fiinctional bladder capacity A normal childcan usually voluntarily hold urine in an amount ofounces equal to his age in years plus two. (A six-year-old child, for example, should be able to hold about eight ounces of urine.) If a child cannothold at least the same number of ounces as hisage, this decreased capacity may contribute toenuresis.

•Increased formation of urine during the night. Ahormone called vasopressin, which is producedby the pituitary gland, reduces urine productionby the kidneys. An increased amount of thishormone is normally secreted during the night.cutting the rate of urine production in half. Sonbed wetters apparently do not secrete more vasopress•n during the night and produce more urinthan their non–bed-wetting peers. A similar restmay occur, regardless of vasopressin levels, if achild consumes liquids before going to bed.

•Difficulty awakening when the bladder is fiill. Witthe general patterns of sleep are similar in bothbed-wetting and non–bed-wetting children, marparents observe that their child with enuresis wiL"sleep through anything" and seems very difficuto awaken during the night.

•A family history of enuresis. Since so many of thefactors contributing to bed-wetting have an inhet-ent physiological basis, it should not be surprisingthat this problem often runs in families. Enuresiis seven times more common in children whosefathers were bed wetters and five times morecommon if the mother had this problem. If bathparents were bed wetters, the likelihood that thechild will have enuresis is greater than 75 percencompared to a 15 percent chance if neither parentwas a bed wetter.

Bedwetting Evaluation

If your child is wetting the bed repeatedly after the fior sixth birthday, an evaluation by your child's physicis a reasonable first step. (Very often this problem canaddressed during a routine checkup.) A careful histoand a physical examination will be performed, akwith any appropriate laboratory studies (such as analysis). A culture of the urine will be taken if thenconcern about an infection. In most cases elaborateagnostic tests are not needed. But if the initial asseinent raises concerns about the structure or functionthe urinary tract, your child's physician will wantevaluate further.

If a child develops secondary enuresis - that is, hebeen consistently dry in the morning for more than sixmonths and then begins wetting the bed again.

ln such as a bladder infection or diabetes mightne manifested in this way.

Other Health Care Articles:

Home :: Contact Us :: About Us :: Privacy Policy :: Terms of Use :: Site Map