As infants grow, several things develop to allow them to gain control over the way their bladder empties:. Being lazy or willful is almost never a reason for a child's loss of bladder control. In a small number of cases, behavior may play a role. No matter the causes, parents need to be patient and supportive.
Bedwetting is caused by a combination of things:. Bedwetting can be inherited. The "bedwetting gene" is strong among families. Half of all children who have this problem had a parent who also struggled with bedwetting. Close relatives aunts, uncles and grandparents may also share this gene, though you may not know it. Children who wet their beds are often described as "deep sleepers. Instead of waking up to use the toilet, the child's pelvic floor muscles relax and empty while the child sleeps.
This brain-bladder control will develop naturally over time, or speed up with treatment. Some children who have enuresis have bladders that can only hold a small amount of urine. This condition does not allow the child to sleep through the night without wetting the bed. Your child's kidneys may make too much urine at night, and the bladder may not be able to hold it all. Normally, the brain produces a hormone called "antidiuretic hormone ADH " which slows the kidney's urine production.
It helps make less urine at night. When the brain does not make enough ADH or when the kidney stops responding to it, more urine is produced. The child will either have to wake up several times during the night to urinate or wet the bed. Caffeinated and carbonated drinks may also cause the kidneys to produce more urine. Type 1 diabetes insulin dependent diabetes mellitus or "sugar diabetes" is caused by a lack of the hormone insulin. This hormone helps manage the sugar we get through food and drink.
In untreated patients with type 1 diabetes, sugar is lost in the urine. This leads to a great loss of water. Some children with type 1 diabetes may have bedwetting as a symptom at the start of their illness. Some children have sleep disorders such as sleepwalking or obstructive sleep apnea OSA. The rectum lies behind the bladder. If constipation causes stool to store in the rectum, it will push on the bladder. This limits the way the bladder can hold urine, causing leaks.
Any form of stress can lead to bedwetting problems. If the stress from bedwetting itself affects your child or your family, it can make things worse. Children who wet the bed often fear being discovered and teased by their friends or siblings. Emotionally, a child can become withdrawn and nervous. Children with learning disorders or attention problems generally feel more stressed.
These children commonly have bedwetting issues. Be aware of social stresses that can affect bedwetting, such as:. You and your health care provider will want to learn the cause of the bedwetting. Your child's pediatrician will ask about how often this happens, and about other symptoms. Before your appointment, try to keep track of your child's bathroom habits in a bladder diary. Include information such as:. There are many treatments for bedwetting, some work better than others. Often, treatment starts with simple changes like:. Begin by encouraging your child to drink 1 or 2 extra glasses of water in the morning or at lunchtime.
Then in the evening, your child should only drink to quench thirst. Try to prevent drinking 1 to 2 hours before bed. Also, limit or stop your child from drinking caffeinated and carbonated drinks like soda. Bladder training is a way to set a bathroom schedule with your child. It triggers a bell or buzzer to go off with wetness. The child wakes with the alarm and tries to get up to go to the bathroom before having an accident. An adult will need to help, since most children who wet the bed sleep very deeply and do not wake up by themselves at first. The alarm works by "conditioning" a child to wake when it's time to urinate.
This is behavioral-type therapy that is known to be very successful. Bedwetting alarms work with a sensor in the child's pajamas or underwear that links to an electronic alarm. The alarm is either attached to the child's clothing near the shoulder or clipped to the waist.
The alarm unit may also be wireless, and placed on the counter. When the sensor becomes moist, the alarm is triggered. Some alarms also have a vibration mode that shakes the device. The alarm wakes the child so he or she can get to the bathroom to urinate or finish urinating. Success for alarm therapy depends on parents understanding that this is a learning process. There are stages that a child and parents must go through for best results.
Without patience, parent and child frustration will lead to quitting. Please try not to give up. In the first and second stage of therapy, parents must wake up with the alarm and then wake the child from bed. The child then gets up, goes to the toilet, and tries to urinate for couple of minutes. The parent should be supportive and help. Then the child will turn the alarm back on, and go back to bed. In the third stage of therapy, the child should be able to wake on his or her own when their bladder feels full. Once the child successfully reaches this stage, parents should ask the child to use the device for more weeks to reinforce this behavior.
Everyone at this stage should feel proud and relieved. In normal conditions, vasopressin is produced by the kidneys when the body tries to conserve water. For example, athletes secrete more vasopressin when they are active and sweating. Most people have naturally higher levels of vasopressin during sleep. That is part of the reason why we can sleep through the night without needing to pass urine. In many children with enuresis, this hormone surge is absent.
DDAVP is available as a pill. It can be given an hour before going to bed for a period of months, with a one week break. Because it works to decrease the volume of urine made, it is used with a schedule of drinking less fluid.
These prescription drugs stop the bladder from having spasms with overactive bladder symptoms. It is helpful when a child has small bladder capacity, by increasing that capacity. Imipramine is an anti-depressant medication that has been used for many years to treat children with bedwetting. It does not mean that depression is a cause for bedwetting. It is not clear how imipramine helps in this case, but it is believed to improve the child's sleep patterns and bladder capacity.
Side effects can include irritability, insomnia, drowsiness, reduced appetite, and personality changes. Overdose can be deadly. This drug must be used and stored safely. Finally, your health care provider should look for signs of constipation.
Treatment with dietary advice and laxatives may be recommended. This may help with your child's bedwetting issue. Many parents think that if their child stops eating and drinking several hours before bed, it will help reduce or eliminate the bedwetting. However, this rarely helps. It's a good idea to stop drinks hours before bed and to always limit caffeinated and carbonated sodas. However, if a child is hungry or thirsty, it is okay to provide small amounts of food and water.
Note: Limiting drinks is needed for treatment with vasopressin drugs. Some families try this more than once during the night. While it can be helpful in the short term, it is hard to continue over time. It is hard on family members and does not always work. Sometimes the child will still wet the bed.
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Adults with bladder control problems may find help with pelvic muscle exercises , like the Kegel. During these exercises, adults are asked to hold a full bladder and try to stop their urine stream.
This effort does not usually help children. Children who hold their urine on purpose during the day may lead to problems with urgency, daytime wetting and even UTIs. Homeopathy, herbal cures and chiropractic practices have not been found to help with children's bedwetting. With treatment, a child who is struggling with bedwetting can find long-term relief. Most often, in time, this problem will end.
However, bedwetting can be extremely stressful for families.
Stop Washing the Sheets
Several things can help you cope as you decide how to manage a child's bedwetting:. Nearly all one-year-olds wet the bed. It is important to understand that with time, most children will overcome bedwetting. In most cases, there is no need for x-rays, or other imaging or urodynamic studies. Your urologist or primary care doctor will decide what tests, if any, are needed after speaking with you and examining your child. The use of absorbent pants does not prevent or delay toileting and continence control.
These products can help reduce stress for children and parents. They can help reduce wet clothing and bedding at night, and prevent embarrassment. Urology Get the Facts about Nocturia and Bed-Wetting. Wearing soiled clothing can lead to body odor and physical discomfort. Having wet clothing pressed against the body for prolonged periods of time may also cause some skin irritation. You may want to remove the soiled clothing before you change the sheets to reduce the chances of discomfort and skin irritation. This can make it easier to change your clothes when accidents occur.
Consider bagging up soiled garments until they can be washed. This will help prevent odors from filling the room. Keep a plastic bag near your bed so you can bag up soiled clothes more easily. If you're traveling or staying at someone else's home make sure you bring a plastic bag to keep near you at night. Clean off the body. Showering is best after an accident, if at all possible. If you're at home and your family or roommates know about the problem you may choose to bathe. If you're staying with someone who doesn't know about your problem, there are more discreet ways of cleaning up.
Use a clean towel or disposable paper towels to thoroughly dry off the soiled parts of the body. If urine-soaked clothing was touching the skin for prolonged periods of time before you woke up, you may want to consider using a talc-based body powder. This can help manage moisture on the skin and prevent irritation and rashes. Put on clean, dry garments. The soiled garments should be put in a laundry hamper or wrapped up in a plastic bag to prevent odors from lingering in the bedroom.
Respond appropriately to someone's bedwetting. Never yell at or punish someone for wetting the bed. Whether it's a child or an adult, no one wants to wet the bed. Be kind and offer assistance any way you're comfortable doing so. If your child wets the bed, help the child get clean and change their clothes. Take off the soiled sheets and bedding. Any soiled linens should be immediately stripped off and put in a laundry hamper or sealed in a plastic bag. The bedding will need to be washed, and if you plan on going back to sleep your room may smell by the morning if it's not properly stored overnight.
You may want to have a designated laundry basket for soiled linens. You can also keep plastic trash bags handy near your bed so that you can seal the soiled laundry up and contain the smell. Ask for assistance. If you find that you're having a difficult time cleaning up the bed, you may need to ask someone for help. This may be particularly relevant if you're spending the night at someone else's house. Wake up someone you can trust to help you clean the bed. A relative or close friend would be ideal. Say something like, "I'm really sorry but I'm not feeling well and I had an accident.
Can you help me clean up? Spot-clean the mattress. Depending on how much urine is released, you may need to clean the mattress in addition to changing the bedding. You'll want to focus on absorbing any residual urine and treating the spot to prevent stains and odors. Spray the affected area with an upholstery cleaner or an enzyme-based pet odor remover. You can purchase these products at most general housewares stores and many grocery stores.
If you don't have an appropriate cleaner at home you can make one quickly and easily.
What Is Nocturnal Enuresis (Bedwetting)?
Mix one teaspoon of dish detergent into one cup of warm water, then transfer the mixture into a spray bottle or dab it in with a towel. Deodorize the mattress. If bedwetting is a frequent problem, the mattress may begin to smell over time. You can remove some odors from the mattress by treating it with baking soda. Apply the baking soda generously; some accidents may require an entire box of baking soda to properly absorb the odors. Baking soda needs time to absorb odors. You can leave the baking soda on your mattress until the morning and vacuum it up then; if you do, just put a clean, dry towel down between the baking soda and the bed sheet.
Wear absorbent undergarments.
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Absorbent underwear is the first line of defense against bedwetting. These products will not prevent bedwetting, but they will make cleaning up much easier and quicker. Absorbent undergarments come in both reusable and disposable forms. They are made for children and adults of varying body sizes.
Stop Washing The Sheets: How To Cure Your Child's Bedwetting
Use a mattress cover. Mattress covers are designed to protect your bed in the event that urine soaks through your clothing and sheets. These products can help prevent wetness and odors from reaching the mattress, making clean up much quicker and less labor-intensive. You can purchase mattress covers at many department stores or through an online retailer.
Limit fluids before bedtime. Reducing the quantity of fluids you consume can help reduce the chances that you'll need to void your bladder during the night. This is particularly true of the quantity and type of fluids consumed later in the day, as drinks consumed closer to bedtime are more likely to affect your body at night. Fluids should be especially limited in the afternoon and evening. These diuretics are also considered bladder irritants and may contribute to increased urination and bedwetting.
Children have smaller bladders that are still developing and seniors have weaker bladders due to age. Adult women who have birthed children may also have weaker bladders.