Bedwetting (also
called nighttime or nocturnal enuresis) is a common problem in many children.
Children learn to control nighttime urination a couple of years after they have
achieved daytime bladder control; this is not expected until a child is between
five and seven years old.

The number of
children with bedwetting varies by age:

-five years of
age: 16% of children have some difficulty staying dry at night

15 years of age:
only 1-2% of adolescents continue to wet the bed, and boys are twice as likely
as girls to wet the bed in this age group.

In the majority
of cases, bedwetting in children is a self-limited condition that eventually
resolves on its own without major interventions.

Bedwetting may be
the result of or associated to one or more of the following:

• The child's bladder is maturing at a slower pace than
  usual


• The child's bladder has a small capacity, meaning it
  can contain a smaller-than-normal amount of urine at a time


• Genetics: it is not uncommon that parents who had
  enuresis as children to be more likely to have children with enuresis


• Diminished levels of vasopressin (a hormone that
  reduces urine production)


• Deep sleep, preventing the child from sensing bladder
  fullness (this is a controversial issue though)

Physical or
emotional stressors may, in rare cases, induce bedwetting, mainly in children
who have already achieved dryness; this is called secondary enuresis. However,
most children with bedwetting do not have an underlying medical problem.

Constipation, an
increasingly common problem in children, can also contribute to bedwetting. So
if you notice that your daughter does not pass stools regularly and when she
does they come out as rather small hard lumps, this ought to be taken care of
as it might hinder her ability to properly control her bladder at night. The
key to managing constipation is to ensure that your daughter drinks enough
fluids per day and has a fiber-rich diet.

A useful tip is
to keep a 24-hour diary of how much fluid your daughter drinks and how much
urine she passes.

Tests: Urinalysis - this is a basic screening test for
underlying medical problems.

Treatment: initial treatment of bedwetting includes education and
motivational therapy. Behavioral alarms or medication may be tried if enuresis
does not improve with these interventions.

Bedwetting
education and advice

• Encourage the child to urinate regularly during the day
  and just before going to bed (a total of four to seven times).


• Avoid sweet/sugary drinks especially in the evening.


• Try to convince your child to drink most of the fluids
  in the morning and early afternoon, this helps prevent overfilling of the
  bladder during the night.


• Every night, remind your child to get out of bed and
  use the toilet when she needs to urinate. Also remind the child
  to empty her bladder immediately before bedtime.


• Stop using diapers at night since these may encourage
  your daughter to continue to sleep and not get out of bed, especially that
  she is older than eight years.


• And please, do NOT tease your child or allow her
  siblings to tease her about wetting her bed.

Behavior
therapy for bedwetting

Self-awakening: this technique helps the child to recognize when the
bladder is full during the daytime, so that she can recognize this feeling
during the night. The child should practice a self-awakening routine before
bedtime every night. Tuck your daughter in bed, have her pretend it is the
middle of the night, and feel that the bladder is full. Ask her to imagine that
her bladder is full and that she should run to the bathroom before it’s too
late.

If self-awakening
does not work, you may awaken your daughter at least once during the night. Start
with turning on the light, saying her name, touching her shoulder or face,
gently shaking, or using an alarm. Once awake, she should get to the bathroom
without assistance. This may be troublesome for both of you, so you may want to
try it during weekends.

Alarm
clocks: a simple alarm clock set to awaken your
daughter around 2-3 hours after she has gone to sleep, regardless of whether or
not she needs to void.

Medication: desmopressin, also known as DDAVP is a medication that decreases urine production. It is used
to treat bedwetting in children. In most cases, motivational therapy and/or
bedwetting alarms are attempted for a few months before desmopressin is
considered. Desmopressin is taken at bedtime to reduce the amount of urine made during sleep. It is
generally recommended as a short-term treatment but can be used on a nightly
basis. The downside of desmopressin is that relapse rates are very high after
stopping the medication.