Nocturnal enuresis, or bed-wetting, can be very embarrassing for kids. Bed-wetters may feel isolated, like they cannot talk to anyone about their problem. They may avoid certain social situations, like overnight camp and slumber parties. Many experience name-calling or are blamed for wetting the bed, even though they cannot help it. Bed-wetting can eventually lead to loss of self-esteem and psychological distress for children and their families.

Possible causes
Bed-wetting is present when a child 5 years old or older wets the bed at least twice a month. The problem is rarely caused by an underlying disorder, such as a urinary tract infection or diabetes. Mostly, bed-wetting is a matter of slow development—some kids just take longer to attain nighttime bladder control.

Sometimes a child who stopped wetting the bed for a year or more starts again in response to emotional upset. Parents’ divorce, a move or the birth of a sibling, for example, could trigger a relapse. However, it is best to have the child’s pediatrician rule out a physical problem if bed-wetting resumes.

Seeking treatment
If bed-wetting doesn’t stop by age 6, the following treatments may help:

• Behavior modification and counseling. The goal of this type of therapy is to help children and parents understand that bed-wetting is a common—and involuntary—problem that most kids outgrow. It should not be a source of shame or guilt. Parents and kids learn techniques that can help improve the problem (See “Tips for Dry Nights”).
   
• Bed-wetting alarms. A few drops of urine set off these alarms. Eventually, the urge to urinate—not the alarm—wakes the child. This method works gradually, but it cures bed-wetting in more than two-thirds of kids who try it.
   
• Medication. An antidepressant called imipramine can improve bed-wetting problems within one week of treatment. After the child has been dry for one month, the medication is tapered off and eventually stopped.
   
• Desmopressin, a nasal spray, is another alternative. Although medications may offer a quick fix, ask your health care provider about side effects.

If your child wets the bed, be supportive. Do not punish your child for accidents. Instead, enlist his or her cooperation in changing the linens and show confidence that the problem will soon be solved.

Tips for Dry Nights

• Use stars to signify dry nights on a wall chart hung in the child’s room. Plan toward a small reward after a certain number of consecutive stars are obtained.
• Restrict the child’s fluid intake for two to three hours before bedtime.
• Make sure the child urinates immediately before bedtime.
• Accompany the child to the bathroom once during the night.
• Never scold or humiliate the child for bed-wetting.

Jeffrey M. Donohoe, MD

Jeffrey M. Donohoe, MD, is a pediatric urologist at the MCG Children’s Medical Center. His clinical interests include minimally invasive surgery, urinary tract reconstruction, urinary obstruction, bladder reflux, voiding dysfunction, undescended testes and hypospadias.

Penny Noto, NP, is a pediatric urologic nurse practitioner dedicated to children with voiding dysfunction, urinary tract infections and other urologic problems.

Dr. Donohoe and Noto are the area’s only dedicated pediatric urologist and urologic nurse practitioner.

For more information or to make an appointment, please call 706-721-CARE (2273) or visit MCGHealth.org/Kids.