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American Academy of Sleep Medicine 
  

 
 

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Bedwetting – Diagnosis & Treatment


Diagnosis


Talk to your child’s doctor about bedwetting concerns. You should consult a therapist if social or mental stress seems to be at the root of the problem. 

You should see a sleep specialist if you/your child isn’t sleeping well or is very sleepy during the day. Another sleep disorder could be involved in this case.

The doctor will need to know when the bedwetting started. He or she will also want to know how often it occurs. Tell your doctor about what has been going on in your life. Share with him or her any sources of stress that you are dealing with. The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use. 

Also tell your doctor if you have ever had any other sleep disorder. Find out if you have any family members with sleep problems. It will also be helpful if you fill out a sleep diary for two weeks. The sleep diary will help the doctor see your sleeping patterns. This data gives the doctor clues about what is causing your problem and how to correct it. 

You or your child should have a complete physical exam. This should include a routine lab analysis of your urine.

The doctor may have you do an overnight sleep study. This study is called a polysomnogram. It charts your brain waves, heart rate, and breathing as you sleep. It also records how your arms and legs move. This study will help reveal if the bedwetting is related to any other sleep disorder. 

Treatment


Treatment for bedwetting begins with a thorough examination. This will rule out any underlying physical causes of the problem. Then other possible underlying causes should be examined. 

The goals of treatment are to reduce the social and psychological impact of bedwetting. Treatments often include one or more of the following methods:

Behavior Modification 


These methods have been shown to be very effective. They often improve nighttime dryness within the first month. During treatment, it is important to minimize the person’s embarrassment and anxiety as much as possible. Parents need to be very patient while waiting for children to outgrow bedwetting.

Behavioral methods include the following:
  • Positive reinforcement - This is a useful way to reward a child for keeping a dry bed. An example is to make a chart that shows the nights when the child remains dry.
  • Periodic waking - This is when you wake the child at certain times of night to use the bathroom. It can also be very useful. Initially, a parent may wish to wake the child. Over time, the parent can allow the child to wake up alone. An alarm clock can be used to wake the child a few hours after going to bed.
  • Fluid Restriction - This is when you reduce the amount a child drinks in the late afternoon and early evening. It also helps to ask the child to use the bathroom just before going to bed. Regular use of the bathroom during the day is also important. This helps the child to maintain a good routine. Fluid restriction should not be made to seem like punishment. It should be done in a thoughtful manner. Use a much smaller glass than normal for liquids during the evening. Use caution during very hot weather to prevent dehydration.
  • Alarm therapy - This is commonly called the “bell and pad” method. It has been shown to be highly effective. Its success rate is about 70%. This method works best with children who are slightly older and motivated. It uses a moisture-sensitive pad that is placed under the child. An alarm sounds when the pad becomes wet. All family members should be committed to this process. The sound of the alarm may wake them during the night. Most children sleep through the alarm. But they tend to stop urinating when it sounds. A parent then should help the child to the bathroom to finish. Wet sheets and pajamas should be changed. The alarm should also be reset. Then the child can go back to bed. This therapy will help some children sleep through the night without urinating. Others may continue to get up during the night to use the bathroom, which is called nocturia. The length of treatment varies widely among children. It may take from two weeks to several months. You should not use this method for more than three months. If the child does not improve after this length of time, then stop the treatment. You can try it again when the child is older.

Surgery

Surgery may be used to correct the underlying cause of bedwetting. This often eliminates nocturnal enuresis. Examples of these root causes include the following:

  • Ectopic ureter and other structural abnormalities in the urinary system
  • Obstructive sleep apnea
  • Heart block

Medication

 
Drug therapy usually is reserved for children who have had no success with behavioral treatments. Medications used to treat nocturnal enuresis include the following:
  • Desmopressin acetate (DDAVP®)
  • Oxybutynin chloride (Ditropan®)
  • Hyoscyamine sulphate (Levsin®)
  • Imipramine (Tofranil®)
Desmopressin (DDAVP®) is an antidiuretic. It is used to treat primary nocturnal enuresis. DDAVP® is available in a nasal spray (10-40 mcg, at bedtime) or oral form (0.2-0.6mg, at bedtime). It is up to 55% effective. It may also be combined with alarm therapy. Side effects of the nasal spray include the following:
  • Nasal discomfort
  • Nosebleed
  • Abdominal pain
  • Headache
It is important to reduce fluid intake when taking DDAVP®. If fluids are not restricted, water intoxication may occur. This condition requires immediate medical attention. Symptoms of water intoxication include the following:
  • Headache
  • Nausea
  • Vomiting
  • Seizure
Ditropan® and Levsin® are anticholinergic medications. They reduce muscle contractions in the bladder. The usual dose is 2.5 mg to 5 mg taken at bedtime. Side effects include the following:
  • Blurred vision
  • Constipation
  • Dizziness
  • Dry mouth
  • Facial flushing
  • Fluctuations in mood

Oral antibiotics

 
These are used to treat urinary tract infections (UTIs) that might be the cause of bedwetting. Examples include the following:

Bactrim®
Amoxicillan
Macrobid®
Levaquin®