SIOUX CITY | For many children, bed-wetting, although uncomfortable and embarrassing, is a part of growing up.
About 15 percent of 5-year-olds will exhibit nocturnal enuresis or bed-wetting, according to Steven Joyce, an internist and pediatrician at Mercy Medical Center. By age 10, 95 percent of children are dry at night.
Frustrated parents approach their child's pediatrician asking, "Why is my child still having nighttime wetting?"
"It's not considered abnormal. There are several reasons for it," Joyce said. "If they've achieved nighttime dryness of six months or so and then start wetting again, some times it's stressors -- the birth of a sibling, parent divorce. Things like diabetes, bladder infections and those sorts of things can also cause some of those symptoms."
Joyce said he asks parents about constipation and encopresis, soiling underwear by children beyond the age of toilet training. Most children express an interest in toilet training around 2 1/2 years old.
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"Bowel and bladder are closely related, so those children will oftentimes have difficulties obtaining bladder control, so we'll ask about stool patterns," he said. "If you don't have good stool patterns, you're unlikely to become continent."
Tests that might be ordered to rule out a physical health problem could include a urinalysis, a blood glucose test and a blood test to measure kidney function.
If there isn't a physical health problem going on, Joyce said bed-wetting shouldn't be too concerning. In fact, he said 1 percent of 15-year-olds still have episodes of nocturnal enuresis.
"It's mostly a social stressor -- parents get tired of washing the sheets all the time, the child is embarrassed and can't do overnights and things like that. It's a struggle," he said.
As bladders increase in size and mature in function, Joyce said the percentage of children who wet the bed gradually decreases with each year of age. He said a whole host of things have to happen in the body to attain complete bladder control, so parents should be patient and understanding.
"If the child could help it, they would. They don't do it on purpose," he said.
While there's no medication that can cure nocturnal enuresis, Joyce said DDAVP (desmopressin acetate) is sometimes prescribed to treat symptoms if the child wants to stay overnight at a friend's house. The antidiuretic hormone, which comes in the form of a nasal spray, regulates how the body uses water. When the drug is stopped, nocturnal enuresis returns.
"Some people use a nighttime alarm that's kind of hooked up in their pajamas," he said. "The first onset of the jammies feeling wet, it'll trigger the alarm to go off and wake the child up. Some of these kids are in such a sound sleep that they don't hear it."
He said waking the child up every two to four hours gets mixed results as well and could cause additional problems if the child isn't getting adequate amounts of sleep. Limiting fluid intake after 7 p.m. and avoiding caffeinated beverages could produce better results.
But if the bed-wetting persists, Joyce said parents shouldn't make a big deal out of it.
"Talk to them and say, 'It's not your fault,'" he said.
