When children urinate without control while they sleep, it is called nocturnal enuresis. It's also known as bedwetting.
Incontinence is accidental or intentional urination in children who are at an age where they should be able to have control of their bladders. Girls usually obtain bladder control before boys do. Incontinence may be diagnosed in girls older than age 5 and in boys who are older than age 6 who are still having urinary control problems.
Causes of Pediatric Bedwetting (Nocturnal Enuresis) Urology Specialists Omaha
The exact cause is unknown, but there are many factors that can make bedwetting worse including:
- Family History
- Slow Development of Brain-Bladder Control
- UTIs - Urinary Tract Infection
- Smaller than Expected Bladder Capacity
- Urine Production - Making Too Much Urine While Asleep
- Sleep Disorder
- Difficulty waking while sleeping
Different types of Pediatric Bedwetting (Nocturnal Enuresis)
- Diurnal Nocturnal Enuresis (wetting during the day)
- Nocturnal enuresis (wetting during the night)
- Primary Nocturnal Enuresis (occurs when the child has never fully mastered toilet training)
- Secondary Nocturnal Enuresis (occurs when the child did have a period of dryness, but then returned to having periods of incontinence)
How is Pediatric Bedwetting (Nocturnal Enuresis) Diagnosed in Omaha, NE?
You'll know if a child has enuresis if he/she is over the age of 6, and often wakes to a wet bed. 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:
- How often does your child urinate during the day and at night?
- How often does he/she pass stool and how hard or soft is the stool?
- Does your child drink fluids before bed?
If your urology specialists Omaha provider needs more information, your child may have a:
- Urine culture & urinalysis: Urine tests are used to check for infection, unwanted blood and other elements in the urine.
- Blood test: Blood tests can check the kidney and thyroid, cholesterol levels and the presence of anemia, diabetes or hormone problems.
- Bladder scan: This type of ultrasound shows how much urine is still in the bladder after urinating.
- Urodynamic testing: These tests check to see how well the lower urinary tract stores and releases urine.
- Cystoscopy: During this test, the doctor inserts a narrow tube with a tiny lens into the bladder to check for a tumor or other more serious conditions.
Pediatric Bedwetting (Nocturnal Enuresis) Treatment Options
There are many treatments for bedwetting, some work better than others. Often, treating bedwetting starts with simple changes like:
- Reducing the amount of fluids your child drinks 1-2 hours before bed
- Creating a schedule for bathroom use (changing toilet habits)
- Bedwetting alarm devices
- Prescription Drugs
These strategies may be tried one at a time, or together.
The following strategies have not been shown to help:
- Stopping food and fluid intake
- Night waking
- Pelvic muscle exercises
- Alternative therapies
Desmopressin acetate (DDAVP)
Desmopressin is made from the hormone "vasopressin".
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 3-6 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.
Oxybutynin and Tolterodine
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.
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