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Understanding Bedwetting

Just the Facts: The Latest Research on Bedwetting

In this era of the Internet and instant communication there is more information available to parents about bedwetting, or nighttime wetting, 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 nighttime wetting is not caused by poor parenting or bad discipline. Genetic studies increasingly support the hypothesis that nighttime wetting 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 nighttime wetting might cause stress and anxiety that can lead to emotional difficulties.

Medically Speaking

Research on the use of medicines in the treatment of nighttime wetting is still pessimistic. The drugs most commonly used for treatment (imipramine, desmopressin, oxybutynin) are prescribed as a stopgap measure until nighttime wetting stops on its own. Except for one study using two drugs simultaneously, these medicines have not been shown to "cure" nighttime wetting when not in use. In fact, according to an 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. Studies have 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 training pants at night for reasons of comfort," says Dr. Michael Ritchey, pediatric urologist at Hermann Hospital in Houston, TX. "I have not found that they respond any differently to our treatment programs compared to those children who continue to soak their bedclothing."

The Subject of Sleep

Much of the popular literature about nighttime wetting discusses the role of sleep patterns, but there is debate about whether nighttime wetting should be classified as a "sleep disorder."

One interesting study in the Swedish journal Sleep 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 non-steroidal anti-inflammatory drug. This and other approaches, however, should only be considered after consultation with a medical expert or doctor.

"I've looked for [information] on the Internet via websites and discussion boards, [from] pediatricians and books on the subject," says Susie. "I trust my instincts and advice that I feel won't negatively affect my child."



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