Communication Is Key With Bedwetting

Taken from the third issue of Quality Care® in 2006

Every day, five 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.

According to a recent study by Amy Dunlop, PNP, there is a significant communication breakdown between parents and doctors on this issue. While 82% of parents want healthcare providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves. Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at routine visits.

The Basics
Bedwetting is rarely caused by a serious medical disorder. In most cases, it results from a combination of three main factors: increased urine production at night, a small bladder capacity, and poor arousal from sleep. 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 doctors do not consider it to be a “problem” until children are at least 6 years of age.)

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.

Treatments
The most effective treatment for bedwetting is a product called the 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 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 is prescribed most often is called desmopressin (brand name: DDAVP). Desmopressin 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.

Summary
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.

Editor's Note

In post-market surveillance, there have been rare reports of acute cerebrovascular thrombosis (also known as a stroke which is when a blood clot in an artery that supplies blood to the brain) and acute myocardial infarction (also known as a heart attack) following Desmopressin ACETATE (drug used to treat diabetes) injection in patients predisposed to thrombus (blood clot) formation, and rare reports of hyponatremic convulsions (seizures) associated with accompanying use with other medications often prescribed for overactive bladder; namely: oxybutinin and imipramine.

Safety and effectiveness in patients under 12 years of age with diabetes insipidus have not been established. Desmopressin ACETATE should be used with caution in patients with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis, heart failure and renal disorders, because these patients are prone to hyponatremia, an electrolyte imbalance in which the sodium level in the blood serum drps to unusually low levels.

About The Author
Dr. Bennett is a clinical professor of pediatrics at George Washington University School of Medicine in Washington, DC. He has been in private practice for over fifteen years. Prior to his current roles, Dr. Bennett spent a decade teaching and practicing primary care pediatrics at the George Washington Medical Center.

Dr. Bennett has written several books, including Waking Up Dry: A Guide to Help Children Overcome Bedwetting (www.wakingupdry.com). This book explains his successful Waking Up Dry Program designed for parents and children to use as a team to achieve dry nights. His most recent publication is a picture book entitled, Lions Aren’t Scared of Shots. It is written for young children who worry about seeing the doctor.