Bed-Wetting

WHEN TO SEE YOUR DOCTOR

* Bed-wetting persists almost nightly after the age of seven.

* Urination is painful.

* Bed-wetting is accompanied by loud snoring.

What Your Symptom Is Telling You

It's not the kids' fault, plain and simple. They're not doing it to make Mom wash the sheets every day. And they're certainly not doing it to embarrass their parents—the kids are humiliated enough and don't have a desire to spread the shame.

Almost every child wets the bed. Most kids simply grow out of it, says Neil B. Kavey, M.D., director of the Sleep Disorders Center at Columbia Presbyterian Medical Center in New York City. Those who don't—and many people into their teens and twenties have not learned to control their bladders while they sleep—can be treated. "They have to know they're not a lost cause," he says.

Symptom Relief

More boys than girls are bed-wetters, physicians who are sleep experts say. Heredity plays a strong role in determining whether the child will wet the bed and when to be concerned if he or she doesn't stop at an early age. "If the father wet the bed until he was nine," Dr. Kavey says, "there's no need to rush to the doctor if the child is six." Still, here are the options to consider.

Remember and confess. "The first goal is to minimize the trauma on the family and especially on the child," Dr. Kavey says. Kids don't enjoy waking up in the middle of the night drenched in urine. Their humiliation can be eased somewhat if parents explain that bed-wetting runs in the family. "You have to look at grandfathers, grandmothers, aunts and uncles," Dr. Kavey says. "And fathers can conveniently forget that they, too, wet the bed when they were young."

Check for medical problems. Urinary tract infections and, curiously enough, severe respiratory restrictions like sleep apnea can cause bed-wetting. If the urinary infection is cured, bed-wetting stops.

Many children who continue to wet the bed also snore and appear to have significantly obstructed upper airways, a condition known as obstructed sleep disorder, according to Dudley J. Weider, M.D., a professor of surgery (otolaryngology) at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. If tonsils and adenoids are removed to treat the disorder, in about three-quarters of the cases studied so far, the soaked sheets dry up.

Poor sleep patterns associated with sleep apnea and obstructed sleep disorder prevent people from drifting into the deepest stages of sleep, Dr. Weider explains. Only during those deepest stages are certain pituitary hormones secreted, and one of them, a natural antidiuretic hormone, seems to regulate the production of urine, he suspects.

As of yet, throat operations aren't performed merely to stop bed-wetting. But for those who have serious breathing obstructions, "the difference is like night and day."

Buy an alarm. Bed pads attached to alarms that ring at the first drop of moisture are still probably the best method to end bed-wetting, Dr. Kavey says. But they should be used only when the children recognize they need to help themselves in stopping. "If they see it as an imposition," he says, "it won't be effective."

Build that bladder. Exercises can help increase bladder capacity and the ability to hold back urination, according to Dr. Kavey. Try encouraging your child to delay going to the bathroom for 10 to 30 minutes after he or she feels the need to urinate, he suggests. Pelvic constriction exercises like Kegels can help them gain more control over starting and stopping the urinary flow. Ask your child's pediatrician to teach your child these exercises, if appropriate.

Don't drink the water? Many pediatricians and bed-wetting experts frown on the idea of restricting fluids before going to bed, Dr. Kavey says. "But it's something to try, if you'd like, because the idea does make sense," he says.

Medicate for special occasions. A few prescription drugs, such as imipramine and DDAVP (a synthetic version of the natural pituitary hormone) can almost miraculously end bed-wetting—but only as long as they're used. "You can use them, say, when your child is going to camp or to sleep over at a friend's house," Dr. Kavey says, "but once you take away the drug, the bed-wetting usually returns."