Bed-wetting in children - What your doctor can do

Bed-wetting in children

What your doctor can do

Are any tests needed?If your child seems healthy apart from the bed-wetting, it is very unlikely that there is a serious cause. The only necessary test is a urine check. Your doctor will send a sample to the laboratory to check for infection, and will also do a simple ‘dipstick’ test to make sure the urine is not abnormal in any other way.

Bed-wetting alarms (enuresis alarms) are suitable for children older than 7 years. They ring or buzz when your child begins to wet the bed. These are the most effective treatment. They wake the child, and this gets him or her into the habit of waking up when urine needs to be passed. There are two main types of alarm. In the UK, you can buy them from ERIC (see useful contacts), or your doctor or practice nurse can arrange for you to borrow one. Even if you decide to buy one, it is important that the practice nurse shows you how to use it properly. Using an alarm requires lots of patience and commitment, but is worthwhile. There are two main types of alarm.

‘Pad and bell alarms’ have a plastic mat that you put into the middle of the bed, where wetness usually occurs. The mat has an electrical circuit within it that is connected by a flex to a bell or buzzer alarm. You place the alarm out of reach so that your child has to get out of bed to switch it off, and then go to the toilet.
‘Mini-alarms’ are neater. They clip onto the child’s nightwear, near the collar. A thin flex connects the alarm to the sensor, which you attach to the underpants or knickers. Wetness activates the alarm. It can be switched off temporarily, but the child has to change into dry clothes to prevent it going off again.

Using a bed-wetting alarm

For at least the first 10 nights, you will probably have to wake your child when you hear the alarm, so that he or she can switch it off and go to the lavatory. You will need to help your child change the sheets and reset the alarm. A ‘baby alarm’ system will help you to hear the bed-wetting alarm when it goes off.
After about 10 days, many children will have learned to wake up promptly to ‘beat the buzzer’, so there will be a smaller wet patch. This is progress, so tell your child how pleased you are.
If your child does not wake with the alarm, make it louder by placing the sound box in a tin.
Be patient. Some children become dry after about 2 months of using the alarm, but many need 4 months.
If your child becomes completely dry using the alarm, carry on using it for a further month.
Bed-wetting alarms do not work for all children. The success rate is about 70%. If after about 6 weeks, there is no progress at all (such as a smaller wet patch, or the alarm going off later in the night), it is best to stop using it, and try again after a few months.
Although about 70% of children become dry while using the alarm, some start bed-wetting again when they stop using it. A study found that 45% of children who had alarms remained dry afterwards (Drug and Therapeutics Bulletin 2004;42:33–7).

Medicines for bed-wetting can be very helpful, but they do not really cure the problem. When the child stops taking them, bed-wetting often occurs again. But they are a useful stopgap, for example, to use during a school trip. You require a doctor’s prescription for these medicines.Desmopressin helps the kidneys make less urine. It can be taken as tablets or as a nose spray. On average, taking desmopressin gives 2 dry nights a week, and about one-third of children will be completely dry.

Desmopressin helps the kidneys make less urine. It can be taken as tablets or as a nose spray. On average, taking desmopressin gives 2 dry nights a week, and about one-third of children will be completely dry.
Oxybutynin and tolterodine are medications that calm overactive bladder muscle. Either may be helpful if your child has daytime wetting as well as bed-wetting, and has to rush to get to the toilet (urgency). They can cause side effects (dry mouth, constipation, blurred vision), but these are minimized by taking the medication at night.
Imipramine is a medication that somehow helps the bladder hold more urine. On average, taking imipramine gives 1–2 dry nights a week. It used to be popular, but is not used much now. It has some side effects and is very dangerous if too much is taken. It is not as effective as desmopressin.