DEAR MAYO CLINIC: My son is 8 and wets the bed a few times each week. We have tried a variety of things to help prevent it from happening, including stopping beverages two hours before bedtime and using a mattress pad with a bed-wetting alarm. Should we take him to see a specialist? Don’t kids usually outgrow bed-wetting by this age?
Mayo Clinic’s Dr. Patricio Gargollo’s response (see below) of an 8 year-old who wets the bed was helpful but at the same time contains important inaccuracies that we wish to correct.
Dr Gargollo is correct when she states that bedwetting is not a medical problem and that there is no need for medical involvement to deal with it.
However, she is incorrect when she writes that, “most children outgrow bedwetting when they reach adolescence”. While some do, many do not. Bedwetting can continue well into adulthood or never spontaneously end. We have worked with thousands of individuals who continued to experience bedwetting, never achieving the dry bed.
Allowing a child a child to “outgrow” the problem may sound comforting and benign. However, Dr Gargollo fails to consider the massive psychological distress and possible life long psychological consequences that can impact a child the longer he/she suffers with the disorder.
Her mentioning of the possible anxiety a bedwetter might experience speaks to her lack of appreciation about the stress the disorder can cause.
While it is true that bedwetting is not a life threatening disorder, if untreated it creates venerability to shame, low self esteem, feeling “different” feeling failure and a profound fear of discovery. Someone who wets the bed always wonder why he or she fail at something that “everybody else can do”.
Children who wet the bed live in fear of sleepovers, overnight camp or any circumstance where their problem is open to discovery by their peers. In our experience, we have encountered horror stories regarding merciless teasing, harassment and rejection of bedwetters by their peers.
Very importantly, a large percentage of child who experience bedwetting suffer from daytime control problems that intensifies their terror about discovery and their sense of shame.
So, “waiting to outgrow it” sounds simple and benign. It isn’t! Parental support by comforting the child helps but cannot keep the child safe from bedwetting threats to his/her psychological well being.
Dr. Gargollo is correct when she writes that, “bedwetting tends to be more common in children who are heavy sleepers”.
However, she is only partially correct. In our 42 years of treating bedwetting for children and teenagers, we know that in 98% of the time, the real bedwetting cause is because of a deep sleep disorder that disrupts the brain bladder connection that the doctor mentioned. We use the following mantra: “all deep sleepers are not bedwetters but all bedwetters are deep sleepers.”
The deep sleep/bedwetting connection was discovered in 1969 by Dr. Roger Broughton at McGill University in Montreal, Canada. His ground-breaking research confirms that deep sleep, while necessary in the healthy sleep cycle, occurs much more often than it should for someone who experiences bedwetting. The sleep is so deep, sound, heavy that it fails to automatically direct the bladder muscle to remain closed when it receives the bladder’s signal to empty. It simply cannot be sufficiently aroused by the bladder’s signal and therefore it fails to do its job.
The deep sleep/bedwetting connection is not anecdotal. We have seen it in almost virtually all of our successfully treated patients over the past forty years. Our findings have been confirmed by articles published in well-regarded journals of pediatric medicine.
In addition, the deep sleep disorder that causes bed wetting is almost always inherited. The thousands of history’s we have taken reveal chronic bedwetting history always contains a blood relative who has experienced enuresis.
Dr. Gargollo is correct when she states “there is nothing the child can or cannot do to prevent bed wetting and you should never punish a child when it happens”. Children and teenager never “want” to wet the bed, nor are they too lazy to stop it. They simply cannot control the faulty deep sleep/bladder connection. They suffer because of this.
The doctor is quite incorrect when she writes, “limiting liquids before bedtime and using a bedwetting alarm may help and are reasonable steps to take”.
She is also incorrect when she writes, “it often takes two weeks to see any response and up to 12 weeks to enjoy completely dry nights”.
If this were true, enuresis would be eradicated and withholding fluids before bedtime and using bed wetting alarms would be the same cure for bedwetting as Dr. Salk’s vaccine is for polio.
Bed wetting alarms alone do not awaken the child from this profoundly deep, heavy, sound sleep. The arousal disorder that is the cause of bedwetting will not allow a bedwetting alarm alone to fully awaken the child and will not end the problem.
So many of our children’s parents report that their child could sleep through vacuuming, a severe thunderstorm or a very loud voice urging them to wake up. School mornings can be fraught with frustration.
Dr. Gargollo is correct when she writes that “medications are available that can slow nighttime urine production, calm the bladder or change a child’s sleeping and waking pattern”. She is even more correct when she writes, “these medications do not cure bedwetting. When a child stops taking them, the bedwetting typically comes back”.
She fails to mention that these medications can have serious side effects that can compromise overall biological functioning. We have thousands of cases we have confirmed that bedwetting is not the result of too much urine production or an overactive bladder.
We have devoted 42 years putting a stop to bedwetting and have seen many so called bedwetting solutions come and go. A vast majority of our patients have experienced deep disappointment at the hands of these bedwetting solutions before reaching out to a real bedwetting expert.
Dr. Patricio Gargollo answer to the above question
ANSWER: bedwetting is common in children your son’s age, especially boys. Most of those children outgrow bed-wetting without any medical care by the time they reach adolescence. If he’s not having any other urinary associated problems, such as accidents during the day or urinary tract infections, it’s not necessary to take your son to see a doctor. If you notice other medical problems that could be connected to the bed-wetting, however, then an appointment with your son’s primary health care provider would be a good idea.
Toilet training is a complicated process. The sequence of events that must happen in both the brain and the bladder, and the connection between the two, for a child’s body to regulate bladder function effectively during the day and at night can take several years.
Many children have no trouble staying dry during the day and yet have persistent nighttime wetting. It’s not clear why some children have problems with bladder control at night, while others do not. But bed wetting tends to be more common in children who are heavy sleepers.
There is nothing a child can or cannot do to prevent bed-wetting, and you should never punish a child when it happens. The techniques you’re using to try to curb bed-wetting — limiting liquids before bedtime and using a bed-wetting alarm — may help and are reasonable steps to take. Just be patient as you work with your son, and try not to become discouraged if the problem doesn’t stop. It usually takes time. For example, with a bed-wetting alarm, it often takes at least two weeks to see any response and up to 12 weeks to enjoy completely dry nights.
If you notice any of the following symptoms, contact your son’s health care provider: unusual straining during urination, a small or narrow stream of urine, dribbling after urination, cloudy or pink urine, bloodstains on underpants or nightclothes, redness or a rash in the genital area, or daytime as well as nighttime wetting. Also, talk to his health care provider if your son is having pain or a burning sensation when he urinates. These symptoms could signal a urinary tract infection, or a bladder or kidney problem. In some cases, accidents during the day as well as at night may be an early sign diabetes, although that is uncommon.
If your son hides wet underwear or bedding to conceal wetting, or if he seems particularly stressed about it, talk to his health care provider about ways you may be able to help your son feel less anxious about bed-wetting.
Rarely, prescription medication may be used to control bed-wetting. Medications are available that can slow nighttime urine production, calm the bladder or change a child’s sleeping and waking pattern. These medications do not cure bed-wetting. When a child stops taking them, the bed-wetting typically comes back.
Keep in mind that most children eventually outgrown bed-wetting. Often, all that is needed is time, support, understanding and patience. — Dr. Patricio Gargollo, Pediatric Urology, Mayo Clinic, Rochester, Minnesota