Decision Focus: Bedwetting

If you feel your child's bedwetting is a serious problem, talk to your doctor about these treatment options.

Wetting the bed can cause your child stress, shame and embarrassment. It's common in children 6 years old and younger and is not usually a sign of a physical problem. Most often, the child will outgrow it. But if your child is still wetting the bed after the age of 6 or 7, your child's doctor may offer some of the following suggestions.

Treatment options for bedwetting
The doctor may first want to do some testing to rule out any possible underlying physical causes. If the symptoms aren't related to a medical condition, there are various treatments your doctor may suggest, starting with behavior changes. This might include limiting fluids before bedtime and waking your child up at night to urinate.

If this treatment doesn't work, bladder control exercises and bedwetting alarms may be suggested next. Other children may respond better to psychotherapy and medication. You may need to try several options.

Options include:

  • Behavioral measures, which support the child in eliminating bedwetting.
    • Limiting nighttime fluids.
    • Waking the child during the night to urinate.
    • Reward systems, such as giving the child a sticker each night she does not wet the bed. When she saves up a set number of stickers, she gets a new toy.
    • Having the child change the sheets when she wets the bed.
    • Encouraging child to keep a nighttime dry chart.
  • Bladder control exercises, which help stretch the bladder so it can hold more urine.
  • Bedwetting alarms with sensors that attach to a child's pajamas. When the sensors detect moisture, the alarm sounds.
  • Psychotherapy, when bedwetting may be linked to depression, posttraumatic stress or other psychological issues.
  • Drug therapy. Several medications are available for children 6 years of age and older. Medication is usually used as a last resort.

Pros and cons of bedwetting treatments

  • Behavioral measures

Pros:

    • No risk or expense.
    • Proven to work in many cases.
    • Changing soiled sheets teaches responsibility. Also, if the child does not want siblings to know he wets the bed, this gives him a sense of control.

Cons:

    • In some studies, waking children at night to urinate made the problem worse.
    • Reward systems can be discouraging when the child has an accident.
    • Changing soiled sheets may be seen as punishment.

  • Bedwetting alarms

Pros:

    • Seen by some doctors as most the effective approach and the first line of treatment.
    • According to studies, the use of alarms has a 60 percent to 85 percent success rate.
    • Less than 35 percent of users relapse once treatment ends.

Cons:

    • Requires family support. Parents should be prepared to get up with their child when the alarm goes off. Siblings should be aware that they need to tolerate the interruptions.
    • Usually takes four to six weeks to see results.
    • Many doctors believe alarms seem like punishment to children and can be a blow to self-esteem.

  • Bladder control exercises

Pros:

  • These exercises help to stretch the bladder so it can hold more urine.
  • Children learn not to urinate as soon as they feel the urge.
  • Children are taught to stop their urine midstream, which helps them strengthen their bladder muscles.

Cons:

  • There is no consistent evidence that proves bladder control exercises are effective.
  • "Holding it" when there is an urgency to urinate can be uncomfortable, unpleasant and humiliating for a child.
  • Drug therapy
    Medication cannot eliminate bedwetting and is used as a last resort when other treatments have failed. Four medications are used to treat bedwetting.

DDAVP - Pros:

    • Decreases nighttime urine production.
    • Success rates are between 10 percent and 65 percent.
    • Combining with another medication may increase effectiveness.
    • Lasts 10 to 12 hours.

DDAVP - Cons:

    • Possible side effects include loss of appetite, headache and nausea. Water intoxication is a possible, but rare, side effect.
    • Relapse rates are as high as 80 percent.
    • Can be prescribed for short time periods only.
    • Children need to urinate excessively during the day when the effects wear off.

Imipramine - Pros:

    • Results are usually seen in a few days.
    • Helps the bladder to hold more urine.
    • Success rates are between 30 percent and 60 percent.
    • Can be used long-term, usually for four to six months.

Imipramine - Cons:

    • Relapse rates are as high as 50 percent.
    • Can cause side effects, such as anxiety, depression, constipation, diarrhea, dizziness, headache, irritability and lethargy.
    • Possibility of irregular heartbeat. Your child may need an electrocardiogram before treatment starts.
    • The most serious problem with this medication occurs if it falls into the hands of younger siblings. The results can be fatal.

Things to consider
Make sure to let your child know that bedwetting is very common and not her fault. Do your best to keep her from feeling embarrassed.

  • Never punish a child for bedwetting.
  • Make sure other children in the family know that teasing will not be tolerated and can make the problem worse.
  • Do not make a big deal out of bedwetting. Lecturing your child will just cause additional stress.

Take your child's personality and feelings into consideration. If you feel a treatment won't work with your child or will in any way cause him humiliation, don't use it.

Finding success
Keep in mind that one of these treatments - or a combination of them - will probably help your child. With your patience and support, your child will most likely conquer her bedwetting problem.

Ressource: 

https://www.ssr.org/network/members/profile?UserKey=b213ce78-ee44-4af8-9811-de5cc81c72cc