Bedwetting in Older Kids
Bedwetting, also known by the medical term enuresis, is a common childhood condition. Technically, children are considered to have enuresis if they wet the bed two or more nights a month after age 5 or 6. According to the National Institutes of Health, five million children in the U.S. wet the bed at night.
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Significance
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Younger children may struggle with sleep wetting until age 6 or 7 without it concerning their parents, as it's common and unlikely to become a problem. In 85 percent of cases, enuresis will stop without requiring any treatment. While 15 percent of 5-year-olds wet the bed, only 2 to 5 percent of teens do. When an older child wets the bed, it's rarely a medical condition or an emotional or psychological concern.
Risk Factors
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Boys make up a significant portion of bedwetters, with boys outnumbering girls 4 to 1. Also, enuresis tends to run in families. If a child has one parent who has a history of bedwetting, the child has a 40 percent chance of becoming a bedwetter as well. If both parents had the condition, the child has a 70 percent chance of having enuresis, too. According to the American Urological Society Foundation, sometimes enuresis will skip a generation, but specific genes have been identified that are associated with bedwetting.
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Medical Problems
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Enuresis is rarely caused by a true medical problem, but there are some conditions that may cause bedwetting in a few cases. A urinary tract infection can lead to wetting, due to an irritated bladder from the infection. Any anatomical abnormality would be discovered through x-ray, but such problems would lead to frequent infections and daytime accidents as well. Neurological problems can cause enuresis, typically from conditions such as spina bifida, spinal cord or brain injury or surgery. Diseases such as kidney disease or diabetes can also create bedwetting problems but they would cause other symptoms as well.
Function
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Generally, enuresis is due to one of three, or a combination, of three factors. The first is that the child does not wake from deep sleep when the urge to urinate occurs. Additionally, the child may experience increased urine production at night, perhaps due to low levels of the hormone vasopressin at night. This hormone signals the kidneys to decrease urine production while sleeping. Another common factor is an overactive bladder that contracts even though not full, leading to a smaller than average capacity.
Prevention/Solution
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According to the American Urological Association Foundation, treatments that have been shown to have a good success rate with enuresis include alarms that detect any wetness and wake the child, the medication DDAVP or desmopressin acetate which signals the body to decrease urine production, and drugs such as oxybutynin and tolterodine that work on the bladder muscles. Decreasing fluid intake typically does not work, and can lead to dehydration in children. Sleep training is cumbersome and according to urologists, not terribly effective either. The antidepressant imipramine has serious side-effects and an overdose can be fatal.
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