Bed wetting puzzling, but treatable

TOTS TO TEENS

September 12, 1995|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,Special to The Sun

Q: My 12-year-old son is still wetting the bed at night. Isn't there anything we can do for him?

A: We hope that you have talked with your son's doctor about this situation (referred to as enuresis) since a number of things can be done to help your son remain dry. The first step is to determine whether you son has primary or secondary enuresis. Primary enuresis means there is no underlying problem while secondary enuresis refers to bedwetting caused by such problems as neurologic disease or abnormalities of the urinary tract. A careful history, thorough physical examination and a few simple lab tests can usually distinguish between the two. If you, your husband and/or other children also have or had this problem, it is likely that your son has primary enuresis.

A clear-cut explanation for primary enuresis is still not available. In general, most people believe children and teen-agers who wet the bed do so because they are unable while asleep to sense the body's normal signals that the bladder is full. Why or how this happens is uncertain.

There are a number of things that may help your son. One is to reassure him that this will likely go away with time and that you understand that it is not something over which he has control. Some teens with enuresis have small bladders and with stretching exercises the bedwetting can be resolved. Others manage to stay dry by training themselves, through mental imagery techniques, to wake themselves before they wet the bed. If your son is drinking fluids right up until bedtime, you may want to have him restrict his fluids to no more than 4 ounces in the two hours before bedtime.

If none of these work, other approaches are available. The most widely used and tested is a bell and pad approach. The new ones are sensitive to but a few drops of urine and either sound an alarm or vibrate in order to awaken the teen-ager before his bladder fully contracts. The long-term success rate with this approach is quite good. There are several medications available as well. One is an antidepressant that temporarily increased bladder capacity while the other is a nose spray that transiently decreases the amount of urine produced at night. Both require a physician's supervision.

We believe that your son should be the one who chooses how he wishes to manage the problem. Regardless of which method he chooses, however, he is likely to "outgrow" the problem in a few years.

Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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