GoodNites®

When bedwetting continues beyond the age of 5 or so, many families choose to take their child to the doctor to rule out physical problems. The first step usually involves a visit to the pediatrician, who, based on their findings, may refer your child to a urologist.

For many children, who are leery of doctors as it is, this can be an intimidating step; however, it is important to ensure your child's health. And by learning what to expect at this visit, both you and your child will be more comfortable and likely get more from the appointment.

The doctor and nurse may start by asking you and your child a lot of questions about everything from your pregnancy to how your child slept the night before. This process is called taking an oral history. "Probably 90 percent of the first visit is talking," says Anne Arnhym, a pediatric nurse at the University of California, San Francisco Children's Medical Center.

During the oral history, it's important to let your child answer as much as possible. "We don't want to hear it all from the parent," says Arnhym. "We want to get a feeling for how the child feels about his bedwetting…"

After the oral history, there will be a brief physical exam. For primary bedwetting – where accidents mostly happen in bed and at night – the examination is straightforward. "The doctor will conduct a physical to make sure there are no underlying problems and will do a urinalysis to make sure there are no problems with infections or diabetes," says Dr. Christopher Cooper, a pediatric urologist at the University of Iowa Hospital.

During the exam, the doctor will usually look at the child's back to check for spinal deformities, feel his belly to see if he's constipated and have him walk on his toes and heels to check coordination. The doctor also will examine the child's genitals to make sure that everything is formed and functioning properly.

If your child is also experiencing daytime wetting, the doctor may conduct more specialized tests to rule out physical problems. "The doctor may use a uroflow meter, which is like a fancy toilet," says Dr. Cooper. "When the child pees into it, it charts the urine flow rate." If the doctor sees an irregular pattern on the flow chart, he will be able to tell if there is something blocking the flow of urine.

The doctor also may take an ultrasound of the child's belly to ensure the bladder is emptying and working normally.

At the end of the exam, the doctor may recommend a variety of options to help manage the bedwetting, but it is up to you to decide how you and your child want to manage the issue. In the end, there is no sure cure other than time and patience.

"The doctor won't dictate treatment – they will recommend several treatments for the parent and child to decide," says Dr. Cooper.

Before you head to the doctor's office, however, there are a few ways you should prepare.

First, prepare your child by discussing why they're going to the doctor and what to expect. "Kids feel uncomfortable about coming in," says Arnhym. "It may help to point out that the other kids who will be in the waiting room are there for the same thing."

"You should definitely discuss the fact that the doctor will be checking their private parts, and it's OK because Mom and/or Dad will be there," says Dr. Cooper. "Most kids, with a little preparation, are OK with that."

Also, talk with your child about your family's commitment to resolving the bedwetting together. "When a child who comes in has an open relationship with their parent, they tend to provide more information that can address the issue and help the child more," says Arnhym. "When bedwetting is taboo and hasn't been discussed, it's hard to find out how the child feels."

To prepare for the physical tests, keep track of your child's daily bowel and bladder habits during the day and at night. For the urine test, your child should try to fill his bladder before in order to give a sample. "Sometimes even with the best intentions and hydration preparations, the child will have to go to the bathroom just before the appointment, so be prepared that it may take a few hours to get a urine sample," says Dr. Cooper.

In advance of the visit, consider how aggressively – if at all – you want to treat the problem. "If the bedwetting doesn't pose a health risk, then it's up to the child and parent, and they should talk about it beforehand to see how they would want to treat it."

While a visit to the urologist is an important step to take, it's equally important to note that one visit will not cure bedwetting. "Getting over bedwetting is a process, it's not something that will be fixed next week or that a medication will fix," says Arnhym. However, whether or not you decide on a specific course of action, one of the best outcomes of the visit is that it opens the topic of bedwetting up for discussion – and that can be one of the best solutions of all.

There are some standard questions the health care provider may ask during your doctor's visit. They include:

• How often does the child wet the bed or have an accident during the day?
• How often does the child urinate, and what is the stream like?
• How often does the child have bowel movements? Does he ever get constipated? Are there any streaks in the bowels? Are the bowel movements especially hard or soft?
• How deep a sleeper is your child? How easy is he to wake up?
• Did either parent have a problem with bedwetting as a child?
• Were there any complications when the child was born?
• How did potty training go? Was your child ever dry?