Your son is not too lazy to get out of bed to use the bathroom at night. Your daughter is not playing a mind control game with you when she wets the bed. Laying down strict rules about getting up at night to use the toilet will not solve the problem.
Relax. The issue of nighttime bedwetting (also called nocturnal enuresis) almost always gets better and resolves itself, given enough patience and time. This is one of those things that most kids just outgrow -- eventually.
Bedwetting is a very common phenomenon, affecting millions of children worldwide. At 5-years old the incidence is one out of every six children. By 15-years old the incidence drops to about 1 out of 75 children. Boys are about twice as likely to have the condition as girls. Most children with bedwetting have absolutely no medical problem causing it. Bedwetting is completely involuntary and a child should never be punished, scolded, or made to feel ashamed for wetting episodes.
Causes for bedwetting are felt to be multiple, some of which may be amenable to some simple measures that may help.
An immature bladder or small bladder capacity may be helped by bladder stretching exercises, where during the daytime, the child attempts to hold the urine for a few minutes beyond the urge to go and then urinates into a container and the volume is measured. A record may be kept of these measurements over a month to see if the bladder is stretching. This can be a little awkward and tedious, and results of this technique are only occasionally helpful according to reports.
Taking the child to the bathroom (even if they don't fully wake up) a couple of hours after they have fallen asleep and just before the parent goes to bed (referred to as lifting) will empty the bladder one more time before the long night. This may begin to get the child accustomed to feeling dry, and it will at least make things a little less wet in the morning.
Genetics is a common factor in bedwetting. There is frequently a first or second degree relative who was a bed wetter (i.e., parent, uncle). This is not amenable to treatment (disowning your relatives doesn't work), but it may be somewhat predictive of the age at which the condition is outgrown. If an uncle stopped wetting at age 10, that may be the family pattern for your child as well.
Almost all parents report that their bedwetting children are deep sleepers. This would make sense in that the children seem to sleep through the sensory cues (the urge to urinate) that wake up other people and signal them to get up and use the toilet.
Medical causes for bedwetting account for a tiny percentage of the cases. Urinary tract infection, diabetes and severe constipation are causes that can be easily diagnosed by a physician with a history, examination and simple urinalysis. If there is frequent and persistent daytime wetting along with the nighttime wetting, the likelihood of a significant medical or psychological cause is greater and should be evaluated more thoroughly.
The most basic treatment for bedwetting is patiently waiting for it to go away. Other measures may be pursued after the age of six or seven, but only if the parents and child are interested and motivated to do more. Success of treatment plans where the parent is motivated but the child is not are almost certainly doomed to failure.
Initial treatment consists of education and motivational therapy. The parent and child have to understand that the bedwetting is involuntary and not associated with a medical issue. The motivational therapy should include a calendar (making one can be part of the process) onto which stickers or stars can be placed signifying levels of success. For instance: blue star for the night means wet but only a little; gold star means dry night; dinosaur sticker or princess sticker means three dry nights in a row. This approach should be tailored to the individual child.
If motivational therapy alone isn't successful, bedwetting alarms are the next line of treatment while continuing the motivational process. These devices are typically used in children older than seven. These require highly motivated children and parents, but in this situation their success rate is quite high (70 percent or more of children are consistently dry at night within four to five months of continuous monitor use). They work by using a sensor that detects the first drops of urine in the underwear. When the sensor is activated, it sends a signal to an alarm device, which is intended to wake the child with a sound, light, or vibration. The alarm helps the child to wake up to the sensation of bladder contractions that immediately precede urination.
In a small percentage of older children with bedwetting who have not responded to other measures, a medication known as DDAVP may be used. It is a hormonal medication, which is available as a pill, and taken at bedtime to reduce the amount of urine made during sleep.
If you have concerns about bedwetting, do not hesitate to discuss these with your pediatrician. There are lots of resources out there that can help. Check out the Bedwetting Store (www.bedwettingstore.com). All kinds of supplies (pull ups, mattress covers, bedwetting alarms) are also available.
