Bedwetting: Your game plan
Most children eventually stop wetting on their own, but it's frustrating not to know when that magical "Wake Up Dry" date will be. For kids 6 and older who are clearly bothered by wetting, Dr. Arca recommends an alarm that has a wetness sensor that attaches inside underwear and rings loudly -- or vibrates powerfully, for more privacy -- at the first drop, so the child can try to make it to the bathroom in time. "It typically takes about 12 weeks for the brain and bladder to be trained to communicate, so you'll need to be patient," says Dr. Arca. But the key to success is a child who truly wants to stay dry. When that's not the case, she suggests parents simply wait it out.
Certain strategies -- such as using waterproof mattress covers and big-kid disposable undergarments such as UnderJams or GoodNites -- can minimize the trauma of bedwetting. Although encouraging your child to help you strip the bed is fine, it's important to make it feel like a team effort and not an exercise in shame.
It seems logical to limit how much your child drinks in order to decrease the chance of his wetting the bed, though there's not much scientific data to back this up. Dr. Posner has seen in his own practice that it can be helpful, so he suggests patients reduce fluid intake after 7 p.m.
You can also wake your child to use the bathroom before you go to bed, and then again in the middle of the night, suggests Dr. Arca. But stop if that doesn't improve things right away. With some children, disturbing their sleep can actually make bedwetting worse.
If your child ever has trouble with her bowel movements, mention it to your doctor. Because of the proven link between bedwetting and constipation, she may want to X-ray your child to see whether she has a backup of stool (a condition called 'megarectum'). If she does, she may need enema therapy along with a mild laxative like Miralax to help remove the stool and restore the condition of the rectal wall, says Dr. Hodges, associate professor of urology at Wake Forest Medical Center in Winston-Salem, North Carolina. ("Imagine a stretched-out T-shirt," he says of the effects of megarectum.)
If alarms and other prevention methods don't work, you may consider prescription medications that can help treat (not cure) bedwetting. A hormone drug called desmopressin decreases the amount of urine produced at night. Used daily in kids as young as 6, it comes in a small tablet; rare side effects include nausea and vomiting. It may take some time to find the dosage that works best for your child, so start it well in advance for occasions like weekend trips or sleepover camp. It works between 12 and 40 percent of the time. After your child has had three months of success, she stops taking it and you determine whether bedwetting is gone for good.
Other drugs, including oxybutynin and imipramine, work by relaxing the bladder so that it can hold more urine overnight. Doctors consider them for kids 5 and older only when all other therapeutic options have failed. Both drugs are usually taken daily for six months or more. Oxybutynin is used most often in kids who have bladder-control problems when they're awake as well as asleep; it's less effective in kids who wet at night only. It comes in a liquid or tablet form and helps reduce contractions in the bladder. The tricyclic antidepressant imipramine is available in tablets, and low doses have shown to cure enuresis in 25 to 50 percent of cases. Rates of bedwetting after stopping it, however, can be as high as 50 percent. Side effects are uncommon but can include sleep problems, upset stomach, and nervousness.
No one solution helped my children stop wetting. My daughter quit the bed alarm after one failed attempt; she never recalled hearing it. Waking her to urinate didn't help, and she never tried medicine. However, neither my son nor my daughter seemed ashamed of wetting at the time; we assured them that everyone's body is different and one day they would be ready to stop wetting the bed. Sure enough, almost magically, one day they were. And their beds have been dry and cozy ever since.
Originally published in the March 2013 issue of Parents magazine.
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