Just the Facts: The Latest Research on Bedwetting to Help Your Child
By Laura Lyster-Mensh
In this era of the Internet and instant communication there is more information available to parents about bedwetting than in the past, but it is often difficult to make sense of it all. With new studies coming out frequently, it's hard to stay on top of the latest health information and understand what may relate to your child.
Here are some studies from the past five years or so that, according to Dr. Patrick C. Friman, director of behavioral pediatrics at Girls and Boys Town in Nebraska, just might be of assistance to you and your child.
It's in the Genes
Some of the biggest news, and a big relief to parents, is confirmation through scientific study that bedwetting is not caused by poor parenting or bad discipline. Genetic studies increasingly support the hypothesis that bedwetting runs in families and is involuntary. DNA research by scientists has even identified possible enuresis genes on chromosomes 13 and 22, which would confirm anecdotal evidence of an inherited problem.
Also important, says Dr. Friman, is the possibility that punitive and guilt-inducing ways a family reacts to a child's bedwetting might cause stress and anxiety that can lead to emotional difficulties.
Medicaly Speaking
Research on the use of medicines in the treatment of bedwetting is still pessimistic. The drugs most commonly used for treatment (imiprimine, desmopressin, oxybutynin) are prescribed as a stopgap measure until bedwetting stops on its own. Except for one study using two drugs simultaneously, these medicines have not been shown to "cure" bedwetting when not in use. In fact, according to a 2002 article in the British Medical Journal, the company that produces desmopressin (ddAVP) was censured in 2002 for "falsely optimistic" statistics on success rates.
Getting Physical
Bladder capacity is also a common topic in enuresis research. A study, appearing in the May 2003 issue of the journal Urology found that children who wet the bed appear to have smaller bladder capacities at night.
Researchers measured the bladder capacity of children with enuresis both during the day and at night and discovered no difference from their peers in the amount of urine their bladders could hold during the day. At night, however, they found that enuretics' bladder capacity during sleep was significantly smaller than during the day.
Such research, according to Dr. Lane Robson of the National Kidney Foundation's Enuresis Committee, is very important. "In my view, the biggest research advancement in the last five years has been the recognition that many of the children with bedwetting have a bladder that acts small at night," says Dr. Robson. "This has many implications for treatment."
Many experts also believe that wearing disposable underpants does not delay a child's ability to develop continence. "Many of our patients wear 'pull-ups' at night for reasons of comfort," says Dr. Michael Ritchey, pediatric urologist at Hermann Hospital in Houston, Texas. "I have not found that they respond any differently to our treatment programs compared to those children who continue to soak their bedclothing."
Researchers also have found some success in sharpening children's signals of fullness through an approach that stretches the bladder's capacity through "retention control."
The Subject of Sleep
Much of the popular literature about bedwetting discusses the role of sleep patterns, but there is debate about whether bedwetting should be classified as a "sleep disorder."
One interesting study in the journal Sleep, in Sweden, concluded that enuretic children do not experience significantly different sleep patterns than their dry peers. They did find, however, that heart rate during sleep did differ in enuretics.
Alternative Approaches
There are some interesting approaches on the horizon, many of which are being researched overseas. A study in the United Arab Emirates reports "markedly reduced bedwetting episodes" with the use of indomethacin, a nonsteroidal anti-inflammatory drug. In addition, Japanese researchers have seen a 40 percent improvement in bedwetting after acupuncture treatments, which increased to 47 percent after two months. These approaches, however, should only be considered after consultation with a medical expert or doctor.
Parents seek information from many sources, but ultimately you must use your own best judgment on what advice to take.
"I've looked for [information] on the Internet via Web sites and discussion boards, [from] pediatricians and books on the subject," says a Susie*, a mother of an 8-year-old in Wisconsin. "I trust my instincts and advice that I feel won't negatively affect my child."