If there’s anything encouraging to tell parents about bedwetting, it is that it usually is not associated with other behavioral or emotional problems, and it usually disappears by the time the child is 8 years old. In the meantime, there are things parents can do that don't involve drugs or humiliation.
One of the most helpful things you can do to stop bedwetting is also one of the simplest. Make sure your child has many opportunities to urinate during the day and immediately before bedtime. Scientific study has found that simply encouraging a child to go to the bathroom more often—and doing nothing else—significantly reduces the number of episodes of nighttime bedwetting.
Another relatively simple intervention is eliminating food sources of glutamate. These roughly correspond to a pepperoni pizza: red meat, cheese, and pureed tomatoes. (The glutamate in whole tomatoes is bound in a way that it takes longer to digest and never reaches nerve tissue unless tomatoes are eaten in massive quantities.) Hydrolyzed vegetable protein, a brown powder used to enhance the flavor of prepared soups and sauces, is another source of concentrated glutamate that must be eliminated from the diet. Glutamate is essential to the startle response in the brain. Some of the latest research shows that when a noise or movement in the middle of the night causes an especially strong urge to urinate, glutamate is involved. Reducing dietary consumption of glutamate will diminish the startle response and may lessen bedwetting. Aspartate, provided by aspartame (NutraSweet), performs a function in the brain similiar to that of glutamate. Diet soft drinks sweetened with aspartame should also be avoided.
However, limiting fluids in general, especially during the day, is not a good idea. Fluid deprivation can cause dehydration. Limiting fluids at night is only modestly beneficial in controlling bedwetting, although some children do much better if they are not given caffeinated soft drinks before bed.
Most other methods of controlling bedwetting require nighttime effort on the part of parents. Alarm systems to wake the child when urination starts do not stop bedwetting by themselves. When the alarm sounds, the child still must get up and go to the bathroom. Parental intervention is usually required the first time the alarm goes off.
Responding to the alarm can be encouraged by appropriate small rewards for going to the bathroom when the alarm goes off and taking away those rewards for not going to the bathroom when the alarm goes off. Alarm systems without rewards are about 70 percent effective, but alarm systems with rewards are up to 98 percent effective. The complication with the reward system, of course, is that the parent must be up when the alarm goes off. It is also important to note that the reward is not for a dry bed, it is for getting up to go to the bathroom when the alarm goes off.
Kegel exercises to control the bladder, often very helpful for adults, are of little use in children, and they should not be attempted at all if the child wets during the day or frequently has to rush to the bathroom. Older children, however, frequently benefit from them.
Prescription drugs for bedwetting also have their limitations. The antidepressant imipramine (Tofranil), available as a generic, is a relatively inexpensive treatment for bedwetting, but since it is a psychoactive drug, it can cause major alterations in the child’s mood and activity levels. Imipramine helps about 1 out of 4 children who are given it.
Hypnosis seems to help some children, and at least one study finds it more effective than imipramine.
Desmopressin nasal spray (DDAVP, Stimate) contains a man-made form of ADH, causing most people to make less urine during sleep. Drinking more fluid just before bedtime cancels out its effect, and eating salty foods makes the kidneys process more fluid to get rid of the salt. Desmopressin only helps slightly more than 1 in 5 children under the age of six, although 4 out of 5 children 6 and older will have dry nights when they use the drug.
Anticholinergic drugs such as hyosciamine sulfate (Donnatal, Spasmolin, and other trade names) and oxybutynin (Ditropan and Ditropan XL), based on chemicals originally found in the herb henbane, relax the bladder and help it hold more urine. This stops urgent trips to the bathroom both day and night. They can be extremely helpful for children whose bedwetting is due to bladder instability, but for many children with bedwetting they are of no value. They can cause nervousness and dry mouth.
European physicians frequently prescribe vitamin B for people of all ages who experience nocturnal enuresis. A relatively old German study found that vitamin B6, in particular, reduces bedwetting. There are no potential side effects from taking up to 1,000 percent of RDAs of the B vitamins.
The primary Chinese herbal treatment for bedwetting, the aptly named Shut the Sluice Pill, likewise is not enough to cure bedwetting—but together with other measures, it can increase chances of successful treatment. This herbal combination that you would need to get from a doctor of Traditional Chinese Medicine or from either of two over the counter herbal formula makers is made with dioscorea (wild yam). It contains phytochemicals that reduce inflammation on the lining of the bladder and make it less likely for an urge to urinate to occur during sleep or during the day. This decreases the number of uninhibited bladder contractions and gives the child greater control over urination, complementing the action of alarm systems or desmopressin. Shut the Sluice Pill is made by Jade Pharmaceuticals, and is sold under the trade names Sang Piao Xiao and Firm Vessel. It is also available from practitioners of Traditional Chinese Medicine.
What else is helpful to know about bedwetting?
∆ Children who start wetting the bed after age 5 usually have had a bladder infection, usually undetected. See a physician if your 6-year-old or older child suddenly starts wetting the bed. Urine with a strong smell is a sign of bladder infection, which also should be treated by a doctor.
∆ Wetting the bed can be a sign of high blood sugars. If you child is constantly hungry and thirsty and frequently wets the bed, or if your child seems to be making an unusually large amount of urine, make an appointment with a doctor without delay, to rule out the possibility of diabetes.
∆ Protect your child from secondhand smoke. The production of antidiuretic hormone is less in the presence of secondhand smoke.
∆ Protect the bed by using a waterproof mattress or a fitted mattress cover under the bottom sheet. Mattress covers must be securely tightened at the corners to prevent the remote possibility of suffocation. For children over 6, place clean pajamas and sheets next to the bed so the child can change if he or she wakes up.
∆ Diapers humiliate older children and do not train them to notice the urge to urinate at night.
∆ To reduce the time required to make the bed at night after accidents, make up the bed in layers: plastic, sheet, plastic, sheet, and so on. This way the parent (and, later, the child) can simply remove the top layer of plastic and the sheet, place them in the tub, and go back to sleep. Noted natural health expert Phyllis Balch pointed out that that works better than using pull-up diapers, which can make a child who wants to be a “big kid” feel like a baby. Using pull-ups also implies, Balch writes, that the diaper will catch the urine and wetting the bed is not a problem that needs to be solved.
∆ Children should not use desmopressin nose sprays when they have viral infections, especially chicken pox or shingles. Blood clots can result.
∆ An interesting side effect of desmopressin is enhanced memory ability. The effect begins 15 minutes after taking the medication and lasts for several hours.
∆ Some recent research has found that teenagers and adults with nocturnal enuresis can be treated with nicotine gum. Nicotine stimulates the production of vasopressin, without changing the total volume of urine produced by the kidneys and without disturbing the balance of electrolytes in the bloodstream.