General Illness Information Common Name: BED-WETTING Medical Term: Enuresis Description: Involuntary urination during sleep in children 5 years of age or older. It is 3 times more common in boys than in girls. The occurrence of bed-wetting in children is: 15% at age 5, 10% at age 6, 7% at age 8, 3% at age 12, and 1% at age 18. Bed-wetting is usually caused by slow maturation ,but it is sometimes accompanied by sleep-walking and night terrors. Causes: In most cases, the cause of bed-wetting is unknown. In only 1 to 2% of the cases, there is an associated physical disorder. The following are the most common causes or theories: Underlying illness, such as diabetes or a urinary-tract infection; A small or weak bladder that cannot hold one night's urine production; Psycho-pathologic problems caused by stress or separation from the mother or arrival of a new sibling; Child who is a deep sleeper. Prevention: No effective preventive methods known. Show your child love, support and understanding for this problem. Signs & Symptoms Bed-wetting at night (occasionally during the day). This is not significant until a child is older than 6. Risk Factors Diabetes. Urinary-tract infection. Family history of bed-wetting (44% occurrence if one parent was bed-wetter, 77% occurrence if both parents were bed-wetters). First born child. Diagnosis & Treatment General Measures: Counseling and behavior therapy- both child and parent receive counseling and are advised that bed-wetting is quiet common and that it will resolve in time and that nobody should feel guilty. Protect the mattress with a heavy plastic cover. Provide the child with extra-thick underwear and pajamas. Discontinue diapers or plastic pants by age 4; they inhibit the child's motivation to improve. Put an extra pair of underwear and pajama bottoms by the bed in case the child needs them during the night. Restrict liquids for 2-3 hours prior to bedtime. Have the child urinated before bedtime. Awaken the child to urinate after he has been asleep for several hours. If the child is old enough, he may be able to set the alarm clock to awaken himself and empty his bladder during the night. Reward the child for staying dry. Praise him and hug him. Use gold stars or happy faces to mark dry nights on a calendar if the child likes it. Respond gently to accidents. Don't blame, criticize, restrict or punish the child who has wet the bed. This can cause him to give up, or lead to emotional problems. Follow instructions for any bladder-stretching or stream-interruption exercises or behavior-modification devices. Try alarms that are triggered by wetting. Reports indicate a 70% cure rate when using them. The only disadvantage is that the treatment works slowly. In most cases, the alarm can be removed afte 3 weeks of dry period. Medications: Usually is not necessary for this disorder. An antidepressant (imipramine) or a prescription nasal spray (vasopressin) may be recommended if other methods fail and the family favors medical treatment. Imipramine is an anti-depressant medication that relaxes the bladder and tightens the bladder sphincter that blocks urine flow. Vasopressin or desmopressin is used as a nasal spray. This drug reduces the output of urine. It has few side effects but is expensive. Activity: No restrictions. Diet: No special diet. Encourage your child to drink as much fluid as possible during the day. Restrict the intake of liquid 2-3 hours before bedtime. Possible Complications : Psychological and emotional scars that may affect the child's personality for years. Prognosis Bed-wetting may continue for several years. Laboratory tests may be conducted to rule out urinary-tract infections and diabetes as causes. If these are eliminated and your child is normal in other respects, consider your child's bed-wetting represents a delay in maturing that will resolve with time.