By Franca Mngu Iorember, MD, MPH

Bedwetting refers to involuntary urination at night while a child is asleep. Bedwetting is considered normal when it occurs in infants and toddlers but by the age of 5, night dryness is expected in most children. However, bedwetting remains a common problem in children older than 5 years of age. It occurs in 15-20 percent of children 5 years of age; 5-10 percent in 10 year olds. By age 15 years, bedwetting is present in only 1-2 percent of children. The annual resolution rate of bedwetting has been estimated at about 15 percent.

The exact cause of bedwetting is not known but a number of factors have been implicated. Bladder emptying is controlled by reflexes in the spinal cord and brain. Any defect in a child’s neurological system can interfere with a child’s ability to urinate voluntarily, leading to bedwetting. In normal individuals, the production of urine decreases at night under the control of a hormone called anti-diuretic hormone (ADH). In children who wet the bed at night, studies have found a loss of this control leading to the production of large amounts of urine at night resulting in bedwetting. Also implicated is the possibility of a maturational delay in the ability of the bladder to sense bladder fullness and stop bladder contraction until wakefulness. In most cases, bedwetting is a benign condition which a child will outgrow. In rare circumstances, it is a result of a structural and functional problem with a child’s urinary tract or the kidneys. Abnormal development of the kidneys and urinary tract or kidney injury from the use of certain types of medications can lead to an inability of the kidneys to hold onto water, which leads to bedwetting. There are also some inherited forms of kidney diseases that can lead to bedwetting. Structural abnormalities of the urinary tract, which cause obstruction of urine flow, can lead to kidney damage and cause excessive urine production and bedwetting.

Caring for a child with kidney disease is an enormous responsibility. The additional burden bedwetting brings upon a child and the family can be overwhelming. Bedwetting can cause major social problems in the family including disruption of normal family activities, sleep interruption and interfamily conflicts, which can all lead to decreased family energy and difficulty coping with your child’s medical needs.

The impact of bedwetting on your child is also considerable. Bedwetting can affect your child’s self-esteem, interpersonal relationships and performance in school. Your child can become embarrassed by this problem and this can limit his or her social interaction with friends and even family members and caregivers.
Your child may be worried about staying over at friends’ houses and may keep away from them as much as possible. Your child can even blame himself or herself for bedwetting and may feel guilty for the problems this creates in the family.

The following are strategies that may help you and your child cope with a bedwetting problem:

1. Discuss with your child’s doctor: It is important for you to discuss your child’s bedwetting problem with his or her kidney doctor so treatment options can be instituted to help your child. It is important to make your child’s doctor understand to what extent this problem has impacted your child and your family. This will enable your child’s doctor to employ all available resources to help your child and your family.

2. Do not blame yourself or your child: It is important for you to recognize that bedwetting is not your child’s fault. It is also not a result of anything you did wrong. You should not feel guilty about this problem or punish your child when bedwetting occurs. Your child’s doctor might be able to help explain why your child is wetting the bed and will work with you to help treat this problem.

3. Discuss with your child: Discuss your child’s bedwetting problem with him or her. It is important for your child to understand they are not responsible for this problem. Do not embarrass your child in front of his friends, siblings or other family members and caregivers. This might lead to withdrawal from others, limited social interaction and loss of self esteem. Avoid making your child feel different from others.

Franca Mngu Iorember, MD, MPH, is an Assistant Professor of Pediatric Nephrology in the Department of Pediatrics at Tulane University School of Medicine. She also has a Masters degree in Public Health from George Washington University School of Public Health and Health Sciences, in Washington, D.C.

This article originally appeared in the January 2009 issue of aakpRENALIFE.

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