Enuresis

Nighttime Wetting (Enuresis)

This educational presentation has been reviewed by clinical staff at Children’s Hospital. However, your child’s needs are unique. Before you act or rely upon this information, please talk with your child’s health care provider. ©2006 Children's Hospital and Regional Medical Center, Seattle, Washington. All rights reserved. Nighttime Wetting - Overview

Nighttime Wetting - Overview
Nocturnal Enuresis is the medical name for wetting the bed at night
This presentation is for children 8-years-old and older (and their parents) who have nighttime wetting

We understand that this can be an embarrassing problem for the family, especially for children. It can be hard to have sleepovers with friends, go to camp, or even go on vacations because of nighttime wetting. We hope to give you some ideas and tools for managing and treating nighttime wetting. Nighttime Wetting - Overview

Nighttime Wetting - Overview Just as kids learn to ride a bike or swim a little differently, kids will learn to stay dry at night differently. What works for one child and family may not work for another !

This is a Team Approach ! Your child cannot do this without their parents help, and parents, this is your child’s issue. You need to offer support, but you can’t do it unless your child is on board and really wants to stay dry! Nighttime Wetting - Overview

20% of all 5 to 6-year-olds still wet the bed at night.
15% of that group will get better each year.
Only 3% of 18-year-olds still wet at night. Over time, almost all kids stop wetting the bed.
Nighttime Wetting - Facts

Genetics : If a parent had nighttime wetting as a child, their children are likely to also. So once again kids, it’s your parents fault (just kidding)!
Gender : Boys are more likely to have this problem than girls. But plenty of girls have nighttime wetting, too.
So, why do some kids wet the bed? No one knows for sure, but there are some causes to consider. Nighttime Wetting - Causes

Psychological : Nighttime wetting may be a result of previous sexual, physical, or emotional abuse. These causes are best dealt with by a family or individual counselor. Once the underlying issue has been addressed, we can work on the physical aspects of bedwetting.
In other words , kids, if you’re really upset about something big that has happened to you, even if it was a long time ago, you need to get help with that first.
Nighttime Wetting - Causes

Physical abnormalities: This means that a part of your body works differently, like having a small bladder, and causes nighttime wetting. It is very rare.
Another example of this is something called a “concentrating defect.” Most people simply make less urine at night, so they do not need to get up to go to the bathroom much. Kids who have a concentrating defect have bodies that do not slow down the speed that they make urine at night, so they make more pee at night than most other kids. This is also very rare.
Nighttime Wetting - Causes

A child’s average bladder capacity is their age + 2 ounces. So, a typical 8-year-old should be able to hold 10 ounces, and a 10-year-old should hold 12 ounces. 8 (age) + 2 ounces = 10 ounces (how much you can hold) Nighttime Wetting - Causes

To help you picture how much that is, 2 ounces is about ¼ cup, or 4 tablespoons. 10 ounces is about 1 ¼ cups, or the size of a glass of water. No matter what your bladder size, everyone should be able to wake up to pee or hold it all night. Nighttime Wetting - Causes

Daytime Problems : If a child has any form of daytime issues (wetting, urgency, or urinary tract infections) they may also have nighttime wetting. It is very important to address the daytime issues first . In these conditions, nighttime wetting is a symptom of the daytime issue.
We have a separate class and presentation for daytime issues. It is called the Bladder Health Class. Nighttime Wetting - Causes

Constipation : If your child does not have a bowel movement (poop) every day, they may be constipated. If the intestines are full there is less room for the bladder to expand and hold pee.
Bladder Nerves Bowel Spine Side View Nighttime Wetting - Causes

To understand what you may need to do to be dry at night we want you to understand how your urinary system works. The Urinary System

You have two kidneys . They sit up at your sides and under your rib bones. Their job is to filter your blood. What’s left after they filter Is urine . The Urinary System

Urine is the fancy name for pee . The urine travels down The tubes called ureters and into the bladder . The bladder is like a storage balloon – it holds the pee until you are ready to release it. The Urinary System

Babies, before they potty train, will get a little bit of urine In their bladders and their bladders will automatically empty. This is a reflex . Like when the doctor hits your knee with a rubber hammer and it makes your leg kick up a little. The Urinary System

When you get older and go through potty training, you learn to stop this reflex . This happens without you even knowing it. The Urinary System

When your bladder gets full, it sends a message up your back (your spinal cord ) to your brain and tells it “I’m full, it is time to use the bathroom!” The Urinary System

You go into the bathroom and your brain automatically tells your brain to stop holding your urine. Your bladder’s reflex kicks in and goes into a contraction and empties. The Urinary System

So right now you are stopping your bladder from the natural reflex of emptying. Your bladder is sending a constant message up your spinal cord to your brain , telling it to hold on! The Urinary System

What happens at night for kids who wet is simple. Your bladder goes back to being like it was when you were a baby. It doesn’t send the message up the spinal cord to your brain . The Urinary System

So when your bladder fills, sometimes even a little bit, it automatically goes into contraction and empties. Your brain never gets the signal to hold on like it does during the day. The Urinary System

Right now, you cannot help your nighttime wetting. The good news is that we can treat it! There are things you can do to stop nighttime wetting. Now, we will talk about how! Treatment – How to Make it Stop

There are many different treatment options. You may have already tried some. Even if you’ve tried some treatments and they haven’t worked, it might be a good idea to try them again. You probably weren’t able to walk, ride a bike, or swim the very first time you tried. With the help of your parents and practice , you were able to do those things. You’ll be able to stay dry at night if you do the same thing… practice ! Treatment – How to Make it Stop

Make sure you’re drinking and peeing enough during the day.
What everyone should do, no matter what the treatment choice: Every child with nighttime wetting should drink at least one sport bottle full of water everyday before 2:30 p.m. Treatment – How to Make it Stop

Go to the bathroom at least every 3 hours during the day.
You should also go to the bathroom ½ hour before bedtime and right before bedtime.
Limit your fluid at dinner (and after dinner) to a half cup.
What everyone should do, no matter what the treatment choice: Treatment – How to Make it Stop

Kids, you need to have a calendar where you record, every single morning , whether you were wet or dry that night. Use stickers, stamps, or a special pen and mark when you were dry.

Be responsible . Last, but not least, let’s talk about responsibility. This is your issue, kids. Mom, Dad, or the adult who cares for you can encourage and support you, but this is your deal to work through.

Ok. Those are things everyone should do. The next treatments are the ones most commonly used for nighttime wetting. You may choose one or more of these options. Treatment – How to Make it Stop

Imipramine is a medicine that is usually used to treat depression. It also seems to help with nighttime wetting, even though we’re not sure why. It may change sleep cycles or it may relax the bladder. It tends to have a 40 to 50% success rate.
Desmospressin Acetate or DDAVP is a synthetic hormone. It helps the kidneys make less urine. Success rates with this medicine are anywhere from 10% to 90%.
Medicines: There are two medicines that doctors can prescribe for nighttime wetting. Treatment – How to Make it Stop

This is the best treatment, and it has the highest success rate. This is also the treatment that takes the most work! By conditioning, we mean training your body to wake up before you start to wet the bed . This is done with a special alarm. The alarms, if used consistently and correctly, have about an 80% to 90% success rate!
Conditioning using an alarm: Treatment – How to Make it Stop

Now that you have some information on nighttime bladder health, you can discuss as a family what options you think may work for you. You should discuss your options with your primary care provider who can prescribe medicines if you need them. To learn more about alarms, ask to view the “ How to use the Wet-Stop alarm ” presentation. Treatment – How to Make it Stop

Thanks!

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Enuresis

by ehealth on Mar 10, 2009

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Enuresis — Presentation Transcript