Prescriptions
Bedwetting is a commonly mishandled problem
By Landis Lum
Bedwetting, a frustrating, embarrassing condition that has been recorded as far back as 1550 B.C., requires a great deal of patience to prevent permanent scars to your keiki's self-esteem.
The first step, of course, is to understand the problem.
Bedwetting, or enuresis, often runs in families. Ordinarily occurring in 15 percent of children, it occurs in 77 percent when both parents were bedwetters, and 44 percent when one parent was.
The actual structural capacity of the bladders of bedwetters is no smaller than non-bedwetters. While some sleep studies show that sleep patterns in bedwetters are not different from those of normal children, a 1997 study by Norman M. Wolfish, a professor of pediatrics at the University of Ottawa, found that bedwetters were harder to wake up: Attempts to wake the children were successful in only 9 percent of bedwetters, compared to 40 percent of other children. In other words, bedwetters appear to be less likely to awake because of a full bladder.
Stresses such as divorce, moving, or unusual or cruel punishment may spark bedwetting.
The bottom line: Bedwetting is never intentional. Instead, it is usually due to maturational delays and genetic factors. Therefore, If you punish a child for wetting the bed, it is not only inappropriate, but can cause psychological damage.
Most parents start to become concerned about bedwetting after the child reaches age 5 or 6. At age 5, about 20 percent of kids wet the bed at least monthly, with about 5 percent of boys and less than 1 percent of girls wetting the bed every night.
Fifteen percent of enuretics finally become "dry" each year. Take your keiki to the doctor for further evaluation, including urine tests.
Bedwetters need to learn to awaken at night to use the toilet. A lot of keiki don't realize this; they feel they have to "hold it" until morning.
So, each night at bedtime, the child should be encouraged to spend a minute reminding himself or herself to wake up at night to use the toilet. A night-light should be left on. The child can even practice: Have your keiki pretend to be asleep, then to awaken, walk to the toilet, then return to bed. If the toilet is too far away, put a portable toilet (or even a bucket) in the bedroom. A great picture book you can read with your child at bedtime is "Dry All Night" by Alison Mack (Little Brown & Co).
If the above fail after one to two months, and your keiki is still wet every morning, ask your child if he wants you to awaken him at your bedtime. Have him walk to the bathroom himself (don't lead him there) and pull down his own pants. Do this every night until he is dry nearly every night for a month, then awaken him progressively earlier, and finally, stop. Don't use diapers or pull-ups, which interfere with motivation for awakening and give keiki the wrong message.
On wet mornings, have your child rinse his pajamas and underwear in the sink until the odor is gone before laundering; he may also need to bathe. Your child does not like being wet, and feels guilty about his affliction. So take the attitude that "it's just one of those things; it's not your fault, and you're trying." Rewards and praise should be given for dry nights.
If this is still going on at age 7, your child may be ready for an enuresis alarm, which has the highest cure rate of any treatment (including drugs). It requires a lot of motivation for both the child (who must want the alarm) and the parents. Any younger than age 7, and the child will likely have a negative experience to such alarms and won't want to try it later on.
The alarm is attached to the patient's underwear and sounds loudly when it becomes wet, at which time the parents often need to escort the child to the toilet, then back to bed with the alarm reset. Examples are Sleepdry, Wetstop and Nytone. There are also silent vibrator alarms such as the Potty Pager.
Don't stop using the alarm too soon. You probably won't notice any difference in your child in the first month. But in the third month, there will be more dry nights; by four to six months, 75 percent of bedwetters are cured. Any relapses usually respond to a short treatment course.
Drugs are not as effective and have high relapse rates as well as sometimes dangerous side-effects. Desmopressin (also called DDAVP) pills or nasal spray can be tried for special occasions (sleepovers or camps), but may require a few weeks to find the right dose.
Dr. Landis Lum is a family-practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.
Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.
