TYPES OF ENURESIS

Enuresis (en-yur-ee-sis) is the medical term used to describe the involuntary discharge of urine beyond the age when a child is old enough to be able to control urination (usually considered to be 6 years of age for nighttime control). There are several types of enuresis:
DIURNAL ENURESIS is wetting that occurs during waking hours
PRIMARY NOCTURNAL ENURESIS is a lack of the achievement of total bladder control during sleep
SECONDARY NOCTURNAL ENURESIS is loss of bladder control that happens after a child (or adult) has been dry a night for a long period of time (usually defined as 3 to 6 months).

What causes bedwetting?

All of the causes of bedwetting are not known. Some doctors believe that children who wet the bed might have small bladders or be such deep sleepers that the urge to urinate does not wake them up. Research has shown that some children with NE have normal-sized bladders and have sleep patterns that are no different from those of non-bed-wetting children.

We do know that bed-wetting is not a mental problem, a learning problem, or a behavioral problem. The child who does not get help or the child who is punished for wetting the bed, however,can develop psychological or behavioral problems because of the way he or she is treated by family members or playmates.

Recent medical research, however, has found that many children who wet the bed may have a deficiency during sleep of an important hormone known as antidiuretic hormone (ADH). ADH helps to concentrate urine during sleep hours--meaning that the urine contains less water and is therefore of decreased volume. This decreased volume usually means that their bladders do not overfill while they are asleep unless the child has had an excessive quantity of fluids to drink just before going to bed. Testing of many bed-wetting children has shown that these children do not show the usual increase in ADH during sleep. Children with enuresis, therefore, often produce more urine during the hours of sleep than their bladders can hold. If they do not wake up, the bladder releases the urine and the child wets the bed.

Each child is unique

In some cases, there may be a physical problem that is the cause of the child's bed-wetting. For this reason, it is very important to have a doctor who is knowledgeable about enuresis examine your child. The doctor must understand your child's problem and consider issues such as how much, how often, daytime habits, and bladder capacity before treatment can be started.

It is important for these children and their families to understand that this condition can be treated successfully.

How common is bedwetting?

Nocturnal enuresis (NE) is a common problem. It is estimated that there are 5 to 7 million children in the United States who have NE. Many children have no lasting problems from bed-wetting, however, some children who wet the bed can develop psychological problems, including low self-esteem. Family members of children with enuresis sometimes become angry and frustrated because of the condition.

Important facts about bedwetting

Bed-wetting should not be thought of as a behavioral problem. There is no medical proof to show that children wet the bed to spite their parents. No child wants to wake up in a wet bed!

Most children WILL outgrow bed-wetting eventually.

If bed-wetting is causing a child or that child's family a great deal of trouble, there are several approaches that can be used to help and, in some cases, cure the problem. It is very important to be patient and to encourage the child who is tryingto stop bed-wetting. Most important of all, parents must understand that punishing or making fun of a child who wets the bed can only make the situation worse.

Guidelines for seeing a doctor

Your child is at least 6 or 7 years old and has never been able to stay dry overnight
Your child is troubled by wetting the bed - even if the child is younger than 6 years
Your child was once able to stay dry but has begun bed-wetting again
You are troubled and frustrated by the bed-wetting
You punish or are concerned that you might punish your child for wetting the bed
Your child wets or has bowel movements in his or her pants during the daytime

Treatments for bedwetting

Exercises and habit-changing
Some doctors recommend bladder control exercises to help stretch and condition your child's bladder and help him of her to become more aware of baldder control as part of learning to stay dry. These exercises include learning to resist the immediate urge to urinate, in order to increase the bladder size, and stopping urine flow midstream to strengthen bladder muscles. It is important to understand that while these exercises may help some children, there are other alternatives if they do not respond.

Changing your child's eating and drinking habits throughout the day and at bedtime may also be recommended. For example, the doctor may suggest that you not allow your child to consume too many fluids containing caffeine (e.g. chocolate and colas) late at night.

"Night-lifting"
This procedure involves waking your child periodically throughout the night, walking your child to the bathroom to urinate, and then returning your child to bed. By teaching your child to awaken and to empty his or her bladder many times during the night, it is hoped that he or she will eventually stay dry.

Moisture alarms
Moisture alarms are considered a useful and successful way to treat bed- wetting. Medical research has shown that moisture alarms have helped many children stay dry. This treatment requires a supportive and helpful family and may take many weeks or even several months to work. Moisture alarms have good long-term success and fewer relapses than medications.

Alarms usually consist of a clip-on sensor probe that attaches to the outside of bed-clothing. An alarm is set off when the child begins to wet the bed. This alarm should wake the child, who will then go to the bathroom to finish the urination before going back to sleep. If the child does not wake up in response to the alarm, the parent should help him or her go to the bathroom. Modern moisture alarms are safe and range in price from $40 to $80.

Hypnosis
Hypnosis is another approach to the treatment of bed-wetting that is being used successfully by doctors trained in this therapy. Hypnosis is less expensive, less time-consuming, and less dangerous than most approaches, because it has virtually no side affects. Recent medical studies show that hypnotherapy can work quickly--within four to six sessions. On the other hand, if your child is not going to benefit form hypnosis, you will know quickly and can then use another form of therapy. The costs for this treatment can vary considerably, depending on the professional providing the sevice and the terms of your insurance plan.

Because hypnosis can give children the power to treat themselves, this form of therapy can also help build you child's self-confidence and self-esteem as well as help with the bed-wetting. As with other forms of therapy, however, the child must be motivated and be willing to assume responsibility for making a change. Your doctor or clinic may know about this therapy, so you may want to ask about it.

Medications
Antidepressants: Over the years, many different drugs have been used to treat children for bed-wetting, including drugs that are usually used to treat depression (ANTIDEPRESSANTS). While these drugs have helped some children, most have not proven to be an effective long-term cure. The drug in this class that is used most frequently is called imipramine. It has been successful in helping bed-wetting in approximately 30% of children. Antidepressants are powerful drugs and some can have serious side effects, especially in children. They must be used with care, under the close supervision of your doctor.

Desmopressin acetate: Desmopressin acetate is a man-made form of antidiuretic hormone that works by substituting for the natural hormone. It helps the child's body make less urine, and thus lessens the risk that the child's bladder will overfill during sleep. Desmopressin acetate is given to the child as a nasal spray. If the child is old enough, he or she is usually taught how and when to use the spray.

Few side effects have been reported in children using desmopressin acetate. Some of the side effects noted have been headaches, runny nose, pain in the nostrils, and nasal stuffiness. Children with certain conditions may require special care in using desmopressin acetate. Your doctor will advise you if your child is in this category.

Desmopressin acetate can work quickly. Some children will be dry after the first night of using the nasal spray. Many doctors recommend using desmopressin acetate for 3 months, followed by a tapering off period to determine if the child can stay dry without the drug. Like imipramine, many children will resume bed-wetting when the drug is withdrawn. If the child becomes wet again your doctor may ask you to restart desmopressin acetate and try to stop it again every few weeks to see whether your child still needs it to stay dry. Some children only use the medication for overnights or summer camp.