Every day, 5 million American children wake up not knowing if their bed will be wet or dry. Many of these children feel embarrassed and ashamed-and some are punished. Bedwetting is almost as common as asthma, but it is often not discussed, even with doctors, because of its embarrassing nature.

A recent study showed a significant communication breakdown between parents and doctors on this issue. While 82% of parents want healthcare providers to discuss bed wetting, most feel uncomfortable initiating the discussion themselves. Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at routine visits.Bedwetting is rarely caused by a serious medical disorder

In most cases, it is due to a maturational delay in the way the brain and bladder communicate with each other at night. There are three main factors that contribute to the problem:

Bladder size

Children who wet the bed usually have a smaller bladder capacity than their peers. This causes them to urinate more frequently during the day and their bladder has less room to “hold” urine at night.

Nighttime urine production

The brain produces a hormone at night that reduces the amount of urine the kidneys make. Some children who wet the bed produce less of this hormone and thereby make more urine while they sleep.

Difficulty waking up

For many years, it was thought that children wet the bed in deep states of sleep. However, recent research has shown that children wet the bed in all sleep states. These studies have demonstrated that children who wet the bed are unable to arouse from sleep when the bladder reaches its maximum capacity.

A fourth factor, which is often overlooked by doctors and parents alike, is constipation. Because the rectum is right behind the bladder, constipation can interfere with bladder emptying or the way the bladder signals the brain that a child needs to go. This can lead to both daytime and nighttime wetting episodes.

There is no magic age when children are ready to work on becoming dry, however, most children show some concern about the problem by the time they are 6- to 7-years-old. (Bedwetting is so common that most doctors do not consider it to be a “problem” until children are at least 6 years of age.)

There are five signs parents can look for to see if their child is ready to work on becoming dry

• He starts to notice that he is wet in the morning and doesn’t like it.
• He says he does not want to wear pull-ups anymore.
• He says he wants to be dry at night.
• He asks if any family members wet the bed when they were children.
• He does not want to go on sleepovers because he is wet at night.

Whether or not a child is ready to work on becoming dry, there are a number of steps parents can take to help children feel better about themselves.

• Do not punish or shame children for being wet at night.
• Remind children that bedwetting is no one’s fault.
• Let children know that lots of kids have the same problem.
• Let children know if anyone in the family wet the bed growing up.
• Maintain a low-key attitude after wetting episodes.
• Praise children for success in any of the following areas: waking up at night to urinate, having smaller wet spots or having a dry night.
• Encourage children to go on sleepovers. (I devote an entire chapter to sleepovers in my book; this chapter can be downloaded from my website for free.)

The most effective treatment for bedwetting is a product called a bedwetting alarm. Most bedwetting alarms are small, battery-operated devices that children wear to bed at night. One part of the alarm attaches to their undershirt or pajama top and the other part attaches to their underpants. When the child urinates, the alarm goes off, creating a loud buzzing sound. The sound is designed to wake the child up and teach him what his bladder feels like when it fills up with urine. As the alarm begins to work, it teaches children to wake up before they wet the bed. Over time, most kids stop waking up at night to urinate. This happens because the bladder learns to hold all of its urine until morning.

There are a few medications available to treat bedwetting. The one that’s prescribed most often is called desmopressin (brand name: DDAVP). This drug works by reducing the amount of urine a child makes during the night. The effects are not long lasting, however, and most children relapse when the medication is stopped. Consequently, doctors generally recommend it for short-term use such as sleepovers, vacations or as an adjunct to other behavioral measures.

So why is it that parents and doctors are not talking to each other about bedwetting? Parents aren’t asking about bedwetting because they’re either embarrassed about the problem or they aren’t sure the doctor can help. Doctors aren’t asking about bedwetting because they assume parents would bring it up if it were a concern. For every child who gives the doctor an indication that something is bothering him, there are many more who would never say a word. The prescription for this situation is simple: Doctors need to ask about bedwetting at routine checkups, and parents need to be more proactive by asking for help if they have a child who is wet at night.

Dr. Bennett is a pediatrician in Washington, DC. He is the author of a self-help guide written for children and parents entitled, Waking Up Dry: A Guide to Help Children Overcome Bedwetting. On his website, www.wakingupdry.com, he posts bedwetting-related information.

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photo credit: Nina J. G. via photopin cc