The causes of this are generally that the child sleeps so deeply that the signal of a full bladder does not awaken the child from sleep, or that the bladder capacity is small or not developed enough to hold urine for a full night. Most often there is a family history of bedwetting. The majority of children that wet the bed have at least one parent or a close relative who had the same problem as a child.
Primary enuresis, when the child has never been dry at night, is not associated with medical problems or disorders. The focus in handling this problem is to avoid embarrassment on the part of the child so his or her self esteem is not affected. A Pull-up of increasing sizes as the child becomes older tends to help manage the problem. As the child becomes older (at least 7 years old) treatment may be considered. DDAVP or Desmopressin is a medication that diminishes production of urine. It can be used for overnights with friends or relatives but does not help the child outgrow the bedwetting problem. If the child is close to outgrowing the problem and is very motivated, intervention may be helpful in accelerating this process. An approach of five different strategies in combination or individually can be used.
1) A Bedwetting Alarm which alarms with detection of moisture is followed by waking up the child and taking him or her to the bathroom in the middle of the night. The principle of this approach is to condition the child to wake up and go to the bathroom before the alarm goes off.
2) A medication Ditropan (Oxybutynin) that limits emptying of the bladder can be taken at bed time.
3) Increasing bladder capacity during the day by trying to postpone release at times when the child has the urge to go.
4) Limiting the amount of fluid intake at night.
5) Avoiding drinks with carbonation, caffeine and citric acid and avoiding milk products in the evening.
Individually, the Alarm System Approach has the highest rate of success, but keep in mind this requires a very motivated child and family since often the only one in the house who does not wake up is the child who is nearest the alarm.
A transition period tends to occur for 6 months to a year prior to the child naturally outgrowing the problem, when some nights the child is dry and other nights they are not dry. If this period lasts more than a year, it is likely that other sleep issues are taking place like snoring or nasal congestion. A pattern of incomplete emptying of the bladder on a regular basis may contribute to the inconsistency of some nights being dry and other nights not, and constipation may limit bladder capacity causing episodes of night time bedwetting.
Secondary enuresis occurs when the child has been dry for 6 months consistently and then has a problem with bedwetting. This is more likely to be a medical problem. Diabetes, Urinary Tract Infection, kidney problems or neurological problems may present in this way. The child should be seen by the Pediatrician if Secondary Enuresis occurs.