Bed-Wetting: The Common Condition We Don’t Want to Talk About

By Jonathan Whitbourne

Hoping it would disappear in a week or two, Mary Anderson told no one that her 6-year-old son, Michael, was wetting his bed. Instead, she tried to remedy the problem herself, attempting everything from nixing his traditional bedtime glass of water to waking him at midnight to use the bathroom. But nothing worked. After three months of frustration and soggy sheets, Anderson finally decided to call Michael’s pediatrician.

Bed-Wetting Myths Exposed!
We separate fact from fallacy -- get the straight story now.

Michael’s bed-wetting as well as his mother’s reluctance to discuss it are surprisingly common. Up to 7 million
U.S. children ages 6 and older wet the bed. Despite its prevalence, and the fact that effective treatments are available, bed-wetting (or nocturnal enuresis) remains a highly under-reported medical condition and a taboo topic, according to a new survey from the National Association of Pediatric Nurse Practitioners (NAPNP) and the Dysfunctional Outpatient Voiding Education (DOVE) Center at The Children’s Hospital of Philadelphia.

“As Americans, we’re still very much Victorians. We don’t feel comfortable discussing bodily functions, especially ones relating to pee and poop,” says Marc Cendron, M.D., a pediatric urologist at The Children’s Hospital in Boston. “Bed-wetting often becomes a family secret because parents view it as their fault, while kids think there must be something wrong with them. Neither wants to talk about it, and suddenly bed-wetting consumes and negatively affects family life.”

It’s this shame and embarrassment that each year prevents millions of kids who wet the bed from getting the medical attention and treatment they need, Dr. Cendron says. What’s more, these kids worry that their secret will be found out and, as a result, may suffer from low self-esteem, exhibit behavioral problems or struggle academically.

“Bed-wetting is not a fatal condition but, if left untreated, it can cause the child significant emotional damage,” Cendron notes.

Bed-Wetting Explained

Few childhood conditions are clouded with more misinformation than bed-wetting. Many parents do not realize that bed-wetting is a health condition, not a behavioral problem that children can control. Perhaps this is because no one knows exactly what causes it. While theories on the subject abound, researchers have been unable to pinpoint a definitive cause, leading them to believe that bed-wetting is “multi-factorial,” or caused by several factors.

“Several factors can come together to culminate in bed-wetting,” says Seth Schulman, M.D., director of the Dysfunctional Outpatient Voiding Education (DOVE) Center at the Children’s Hospital of Philadelphia. For instance, some children may be deep sleepers who do not wake easily when their bladders are full and need to be emptied. Others may not produce enough vasopressin, an anti-diuretic hormone that tells the kidneys to curb urine production while you sleep.”

The causes of bed-wetting may be ambiguous and open for debate, but the act itself is straightforward and easy to identify. Bed-wetting is when urine is involuntarily released at an age – usually 6 and older – when bladder control should have been achieved.

There are two types of bed-wetting:

class=MsoNormal>Primary nocturnal enuresis (PNE) describes bed-wetting since infancy. About 95 percent of those who wet the bed fall into this category.

class=MsoNormal>Secondary nocturnal enuresis (SNE) is the sudden onset of bed-wetting after a child has been completely dry for at least six months. This condition is quite rare and often attributed to stress, such as the arrival of a new sibling or a move to a new house.

class=MsoNormal>Both types of bed-wetting are curable and should be brought to the attention of your health-care provider, who will examine your child as well as discuss treatment options.

class=MsoNormal>“Treatment begins with communication and understanding,” Dr. Schulman says. “Once you’ve identified the problem and spoken to your doctor about it, you can focus on the task at hand – keeping your child dry through the night.”

class=MsoNormal>Treatment Options

class=MsoNormal>There are many ways to treat bed-wetting, but reprimanding your child isn’t one of them.

class=MsoNormal>“Never punish a child who wets the bed,” Cendron cautions. “It’s not the child’s fault, and it simply won’t work. If anything, it will complicate the situation.”

class=MsoNormal>Instead, parents can choose from effective treatments that fall under two major categories:

class=MsoNormal>Non-medication therapy teaches kids not to wet the bed through a behavior modification program. Often, this program centers around a moisture-activated alarm that attaches to the child’s underwear and beeps or vibrates when he starts to wet the bed. Parents are then encouraged to document their child’s progress with a simple “behavior/reward system.” For instance, parents might add a sticker to a colorful chart for each night the child stays dry. Once the child gains a certain number of stickers, parents can reward him with a special treat.

class=MsoNormal>Non-medication therapy has a success rate of more than 70 percent, according to recent studies, but it takes time. “I always tell parents that it could take months, maybe years before their child is consistently dry,” Cendron says.

-SIZE: 10pt; FONT-FAMILY: Verdana">• Medication therapy involves prescription drugs that reduce the amount of urine produced at night. The most commonly prescribed anti-bed-wetting medication is DDAVP (or desmopressin), a synthetic hormone available in nasal spray or tablet form. Given at bedtime, DDAVP is quite safe and often effective – up to 60 percent of patients respond favorably and stop wetting the bed right away.

-SIZE: 10pt; FONT-FAMILY: Verdana">Some doctors may also prescribe an anticholinergic, such as Detrol or Ditropan, which relaxes the bladder muscle and reduces spasms that may result in bed-wetting.

-SIZE: 10pt; FONT-FAMILY: Verdana">However, medication therapy does have drawbacks. For starters, not every child will respond to these drugs. Those who do must continue taking medication or they may start wetting the bed again because these drugs are treatments, not a permanent cure. For these reasons, many doctors recommend a program that combines both medication and non-medication therapies.

-SIZE: 10pt; FONT-FAMILY: Verdana">“The successful treatment of bed-wetting is a process, not an overnight success,” Schulman points out. “There are many effective treatments available, but what’s equally important is that parents remain patient and sympathetic while reassuring their child that the bed-wetting isn’t his or her fault.”

-SIZE: 10pt; FONT-FAMILY: Verdana">And that’s exactly what Mary Anderson did with Michael.

-SIZE: 10pt; FONT-FAMILY: Verdana">“I learned that bed-wetting is a physical condition, not a ‘problem’ to be solved with ‘tough love,’” Anderson recalls. After much discussion, Anderson and her health-care provider decided that Michael would benefit most from a combined treatment of DDAVP and a moisture-activated alarm. That was eight months ago; Michael has been dry for just over six months.

-SIZE: 10pt; FONT-FAMILY: Verdana">“Since treatment began, I’ve noticed lots of positive changes in Michael,” Anderson says. “He’s more confident, he’s doing better in school, and he’s even made new friends. Next weekend he’s going to a slumber party – and he’s excited about it! I never thought I’d say that.”

Conflicting messages and half-truths such as these have done much to transform bed-wetting into a frustrating, taboo issue. So what should you believe?  Read on...

Jonathan Whitbourne is a former Web editor for United Parenting Publications and a longtime health writer and editor.