Heavy Sleepers

This week’s guest columnist is Dr. Dylan Poche, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I had the same dream every time I wet the bed: I’d be at summer camp, walking out to the camp flagpole, and I’d urinate on it.  When I woke up, the bed was wet.  As I got older, I realized the connection between the dream and wetting, and in the dream would struggle to awaken before peeing on the pole.  About age 9 I I’d wake up as I was peeing on the pole, and go finish in the toilet.  Finally, by 10 years-old, I’d wake up as soon as the dream started and keep dry.

Bedwetting, “nocturnal enuresis” in doctor-talk, is common, and troubling for both children and their families.  It’s defined as involuntary bedwetting in kids otherwise potty-trained by age 5.  Up to a quarter of kids wet at age 5. These kids seem to be deep sleepers, not awakened by the urge to pee. There’s a genetic component, possibly involving maturation of the nerve pathway from bladder to brain.  When I was in medical school and learned this, I asked my parents about it.  Sure enough, dad wet the bed until he was 10, as did my grandfather!

The good news is that it usually resolves on it’s own, but can be alleviated sooner with  treatment.  However, kids who wet after having been dry for awhile might have something else, like urinary tract infections (UTI).  In other words, children who’ve been dry for months or years, and then wet, could be getting sick.  Sometimes it’s something like a stomach virus.  If your child has burning or belly pain with urination, it could be a UTI.  Other signs of infection are fever, foul-smelling urine, or extra frequent urination.  See your doctor for a urine test, since UTIs require antibiotics.

If it’s simple bedwetting, there’s lots of ways to approach this problem.  The easiest thing is restrict your child’s fluid intake in the evening.  This means not drinking a lot with dinner, certainly nothing sugary that kids will chug because it tastes good.  After dinner, minimal water, and have them pee just before bed.

I know of an old Cajun, Uncle Jim, who wet the bed as a child.  He grew up in the 1930s, sharing the attic bedroom, and beds, with six brothers.  When a brother pulled “Jim duty” and shared Jim’s bed, he also shared getting wet.  Finally the brothers, being clever Cajun-types, solved the problem: they propped up their side of the bed with bricks, so that the bed angled down towards Jim.  The high brother stayed dry.

Nowadays there’s better solutions to bedwetting.  Like we mentioned above, the vast majority of kids outgrow bedwetting, usually by around age 7.  A few kids wet into their teen years, but eventually stop.  In Uncle Jim’s day, it was sometimes seen as a psychological problem (Uncle Jim was mean, after all), but now is recognized as a benign issue.  These kids are simply heavy sleepers who aren’t awakened by the urge to go.

There’s things you can do to alleviate this issue sooner.  Like we said above, limiting fluid intake in the evening can make bladders less full.  Often the child needs to drink more during the day, so at night they aren’t drinking to catch up on hydration.  Also, making the child urinate just before bed, and even waking him up to pee soon after he falls asleep, can help make dry nights.  You can buy bedwetting alarms that have a sensor in the child’s pants.  When the sensor gets wet, the alarm wakes the child.  It takes time, but eventually he’s trained to wake up when he’s about to urinate, so he can use the bathroom.

Wetting the bed is of course embarrassing.  Punishing the child for wetting the bed only makes things worse.  It’s best to de-stigmatize the situation by calmly telling the child it’s normal, and decrease his guilt by having him help wash the bedclothes. Encase the mattress in a water-proof cover to prevent permanent urine smell.  Enforce a strict no-teasing policy with siblings.

Occasionally, doctors prescribe medicines to prevent bedwetting, like desmopressin or imipramine.  First the doctor needs to see the child to ensure there aren’t other medical reasons for the bedwetting, like urinary tract infections or constipation; and that the more benign interventions haven’t worked.  Including bricks under the bed.

Wet The Bed? It’s Okay.

This week’s guest columnist is Dr. Frank Betanski, a family practice resident at the University Hospital and Clinics here in Lafayette.

If you have kids, especially a son, you may know the feeling: waking your child in the morning, pulling back the sheets, and getting the pungent smell I call the “Ammonia Sunrise.”  Nocturnal Enuresis (fancy words for bedwetting) is a common problem. Parents of kids who wet the bed come in feeling frustrated and helpless.  The kid has been potty trained for years- except at night!  Bedwetting takes a toll on the patients too. Embarrassed to go on sleepovers, they feel left out. Summer camp or overnight visits to relatives can also be sources of stress rather than anticipation.  I have even heard parents broadcasting their daughter’s daily accident tally at preschool pick-up!  That’s not helping the embarrassment, mom and dad!

Let’s start with facts: 1) Bedwetting is defined as urination that happens at an inappropriate time and place.  2)The diagnosis of Nocturnal Enuresis is not made until 5 years old; nighttime dryness is actually the final stage of potty training.  3) At 5 years old, one in five children still wet the bed.  4)  Its genetic, not psychological.  If mom or dad wet the bed, there’s a good chance the child will too.

Bedwetting was once thought to be a psychological condition.  We now know that children who wet the bed do not have emotional problems.  Bedwetting is not an act of rebellion or laziness.  It is so common that it can hardly be called “abnormal.” Bedwetting is also not a result of harder-sleeping children.  Sleep studies have shown that children who wet the bed sleep no deeper than other kids.  Surveys of parents, however, show that they still think their kids who wet the bed are “deep sleepers!”

How can you treat bedwetting?  The best treatment is the bedwetting alarm.  Originally developed in 1938, it is now found at most shopping centers.  The alarm has been shown to be 75% effective.  The alarm has sensors in the child’s pajama bottoms that detect wetness.  When the child begins to urinate, the alarm wakes the child up.  He then gets out of bed and finishes peeing in the toilet. The idea is that the child learns to wake up when he feels a full bladder and goes pee in the bathroom before going in the bed.

The bedwetting alarm also has a high “found in the trash” rate- 20% of parents get frustrated when the device does not train the child right away, and toss it.  This is because the bedwetting alarm is a training tool, not the training!  Parents have some work to do to make it effective.

First, parents shouldn’t fuss at their children when they wet the bed.  Its not their fault! Reassure that they are not misbehaving.  Praise them when they help clean up and change the sheets: it’s an opportunity to teach responsibility.  When the child is awakened by the alarm and has some urine left over to pee into the toilet, it’s high-five time!  They may not be dry-all-night yet, but they are on their way.  Be patient- it takes many nights for the alarm to help.

Limit fluids, especially caffeinated drinks, before bedtime.  Certainly no sodas or sugary juices at dinner or after.  These drinks are so tasty that children will drink and drink and take in more fluids than they need.  You don’t want a bursting bladder after bedtime.

Some parents wake their kids up to use the bathroom one or two hours after they fall asleep.  For sleepovers have your child wear a pull-up.  This sounds odd but can make a big difference.  If they are embarrassed about the pull-up, send them in loose-fitting PJs- no one needs to know.

Sometimes kids are prescribed medicines to stop bedwetting, but the American Academy of Pediatrics cautions that these drugs are a last resort and not recommended for children under 5 years old.  These medicines may help in the short term, but do not solve the problem in the long run.

When to see your doctor?  When the child has had nighttime dryness, and then begins to wet the bed again.  This can be a sign of a new medical problem such as urine infection, diabetes, constipation, or stress.

But if your child has wet the bed since successful daytime potty training, don’t stress. Teach them to help clean up, and that it’s okay.