Enuresis

Bedwetting (or nocturnal enuresis or sleepwetting) is involuntary urination while asleep. It is the normal state of affairs in infancy, but can be a source of embarrassment when it persists into school age or the teen years.

Primary enuresis is when the child has never been dry at night or would not sleep dry without being taken to the toilet by another person or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness. Secondary enuresis occurs when a child goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis is often caused by emotional stress.

Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.


 * One is a hormone cycle in which a minute burst of an antidiuretic hormone happens daily at about sunset reducing kidney output of urine well into the night so the bladder doesn't get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six, others between six and the end of puberty, and some not at all.
 * The other is the ability to awaken before sleepwetting. For some children this is a natural extension of learning to be aware of and control their bladders while awake. For others, a variety of factors suppress or disrupt this awareness when asleep, and they are unlikely to develop it. Taking children to use the toilet while not fully awake can prolong dependence on that by encouraging them to urinate while nearly asleep.

Prevalence
Figures commonly cited suggest that enough children sleepwet at age six (perhaps one in three) so that it is within normal expectations and supportive management is appropriate until a child is seven or eight or has the maturity and desire to take an active role in planning and implementing specific treatment. Also, even with no active treatment, about 15% (one in seven) of children who do sleepwet will stop each year through natural development. Some source indicate that 5-10% of teenage children experience occassional sleepwetting.

Treatment
One prescription drug used to treat bedwetting with much success in older individuals is Imipramine, which is also a very mild antidepressant sometimes used to treat ADD/ADHD.

Another medication, DDAVP, is a synthetic replacement for the missing burst of antidiuretic hormone. Whether used daily or occasionally, DDAVP simply replaces the hormone for that night with no cumulative effect.

Some psychologists and experts recommend the use of night-time training devices such as a bedwetting alarm to help condition the child first to wake up at the sensation of moisture and then at the sensation of a full bladder. Success with alarms is increased and relapses reduced when combined in programs which may include bladder muscle exercises, dietary changes, mental imagery, stress reduction, and other supportive activities.

Using absorbent products such as diapers or other products like Huggies' GoodNites pants usually helps bedwetting children feel less embarrassed about their accidents. Although these products will not treat or cure bedwetting, they make it easier for children and their families to deal with the issue. A diaper or pullup is especially needed at sleepovers and while traveling. A child who has night wetting accidents and wants such protection should be allowed to have it. Use of such products should be appropriate to the child’s age and size and never used to punish or embarrass or deny reasonable privacy.

Still, the use of diapers or disposable training pants such as Pull-Ups without any other treatment is not considered unusual until about 6 to 8 years of age. After that point, other treatments may be used with or without absorbant products, such as the aforementioned medication or alarm systems. Occasional bedwetting such as once a month to once a year is normal for a child between 4 and 16 and nothing to get alarmed at.

There is however, a growing number of voices against the use of such products as Pull-ups, because some parents feel that they can hinder, rather than help the process of assisting with bedwetting; since some children appear to treat them and indeed use them, as a substitute diaper.

Experts generally agree that parents' understanding that sleepwetting is not the child’s fault strongly increases the child's willingness to help deal with it. Although historically, physical punishment was the normal method of incentivizing older children to stop sleep wetting, anti-spanking advocates have discouraged any corporal punishment for this purpose. Punishments including restrictions, teasing, or shaming, whether actual or threatened, are counterproductive. Encouragement of self reliance allows for the child's own natural and native development to acquire the ability to sleep dry on his or her own terms.