What causes bed wetting?
Enuresis, or bed wetting, is common and often runs in families. It may occur in children with increased urine production at night, smaller bladders, and even decreased neurological awareness of bladder distension (i.e., the brain hasn’t learned yet how to tell when the bladder is full). Toddlers will generally achieve daytime continence of bowel and bladder function before they achieve nighttime control. Most kids will take an interest in daytime potty training by age two-three. On average, children will achieve daytime continence by age four and nighttime continence by age six. After age six, nocturnal enuresis (or bed wetting) is considered to be abnormal. Most bedwetting generally occurs in the early portion of the night. In general, most children are upset and ashamed about bed wetting. It is important to let the children know that bedwetting is a common problem and that other members of their family have likely already had bed wetting and outgrown it.
What can be done to treat bed wetting?
It can be due to the timing of the last void (i.e., last potty break) and to the amount of liquid ingested after dinner. It can also appear in a previously dry night child during periods of stress or illness. In general, kids with bedwetting may be evaluated for allergies, diabetes, bladder infections or abnormalities, constipation, and sleep apnea. A Pediatrician, Pediatric Urologist or Sleep Specialist can do these evaluations. Both behavioral treatments (i.e., reward systems, nighttime fluid restriction, bladder training, and timed voiding or potty visits) or medications can be used if no underlying condition is found. Children are instructed to delay daytime voiding (urinating) for increasing intervals (i.e., 2, 5, 10, and 15 minutes) to improve bladder control. They are given multiple scheduled opportunities to go to the bathroom (especially before bedtime). Fluid is restricted after bedtime and children are not allowed to continue to drink beverages before bed or during the night. Reward systems (i.e., stickers, toys) are given for their participation. If severe and persistent, and no underlying cause is found, a brief trial of medications may be used to help achieve nighttime continence. The most commonly used medication is imipramine. This medication is usually well-tolerated, but rarely can cause changes in blood sugar, depression, photosensitivity, and make children more prone to infection. It also can provoke sleep walking. The use of a bed pad (“incontinence pad” or “chuck”) either disposable or washable, may help to speed up clean ups in the middle of the night and decrease sleep disruption.
What about the elderly who have bed wetting?
Nocturnal incontinence in adults is a very common and frustrating problem, both for the mature adult and for the caregiver. All adults with incontinence should undergo a thorough evaluation with either their Primary Care Physician (General or Family Doctor) or with a Urologist. If this cannot be managed medically, mature adults may benefit from nocturnal diapers, incontinence bed pads (disposable or washable), self-bladder catheterization (using a tube to empty the bladder prior to sleep) or condom catheters for men and nocturnal Foleys for women.