Heavy Sleepers

This week’s guest columnist is Dylan Poche, M.D., Family Practice resident at University Hospital & Clinics in Lafayette.

I had the same dream every time I wet the bed: I’d be at summer camp, walking out to the camp flagpole, and I’d urinate on it. When I woke up, the bed was wet. As I got older, I realized the connection between the dream and wetting, and in the dream would struggle to awaken before peeing on the pole. About age nine I’d wake up as Iwas peeing on the pole, and go finish in the toilet. Finally, by 10, I’d wake up as soon as the dream started and keep dry. Bedwetting, “nocturnal enuresis” in doctor-talk, is common, and troubling for both children and their families. It’s defined as involuntary bedwetting in kids otherwise potty-trained by age five. Up to a quarter of kids wet at age five. These kids seem to be deep sleepers, not awakened by the urge to pee. There’s a genetic component, possibly involving maturation of the nerve pathway from bladder to brain.

When I was in medical school and learned this, I asked my parents about it. Sure enough, dad wet the bed until he was 10, as did my grandfather! The good news is that it usually resolves on its own, but can be alleviated sooner with treatment. However, kids who wet after having been dry for a while might have something else, like urinary tract infections (UTI). In other words, children who’ve been dry for months or years, and then wet, could be getting sick. Sometimes it’s something like a stomach virus. If your child has burning or belly pain with urination, it could be a UTI. Other signs of infection are fever, foul-smelling urine or extra frequent urination. See your doctor for
a urine test, since UTIs require antibiotics.

If it’s simple bedwetting, there’s lots of ways to approach this problem. The easiest thing is restrict your child’s fluid intake in the evening. This means not drinking a lot with dinner, certainly nothing sugary that kids will chug because it tastes good. After dinner, minimal water, and have them pee just before bed. Next week: more on
treatment.

I know of an old Cajun, Uncle Jim, who wet the bed as a child. He grew up in the 1930s, sharing the attic bedroom and beds with six brothers. When a brother pulled “Jim duty” and shared Jim’s bed, he also shared getting wet. Finally the brothers, being clever Cajun-types, solved the problem: they propped up their side of the bed with bricks, so that the bed angled down towards Jim. The high brother stayed dry. Nowadays there’s better solutions to bedwetting. Like we mentioned last week, the vast majority of kids outgrow bedwetting, usually by around age seven.

A few kids wet into their teen years, but eventually stop. In Uncle Jim’s day, it was sometimes seen as a psychological problem (Uncle Jim was mean, after all), but now is
recognized as a benign issue. These kids are simply heavy sleepers who aren’t awakened by the urge to go. There are things you can do to alleviate this issue sooner. Like we said last week, limiting fluid intake in the evening can make bladders less full. Often the child needs to drink more during the day, so at night they aren’t drinking to catch up on hydration. Also, making the child urinate just before bed, and even waking him up to pee soon after he falls asleep, can help make dry nights. You can buy bedwetting alarms that have a sensor in the child’s pants. When the sensor gets wet, the alarm wakes the child.

It takes time, but eventually he’s trained to wake up when he’s about to urinate, so he can use the bathroom. Wetting the bed is, of course, embarrassing. Punishing the child for wetting the bed only makes things worse. It’s best to de-stigmatize the situation by calmly telling the child it’s normal, and decrease his guilt by having him help wash the bedclothes. Encase the mattress in a water-proof cover to prevent permanent urine smell. Enforce a strict no-teasing policy with siblings.

Occasionally, doctors prescribe medicines to prevent bedwetting, like desmopressin or imipramine. First the doctor needs to see the child to ensure there aren’t other medical reasons for the bedwetting, like urinary tract infections or constipation; and that the more benign interventions haven’t worked. Including bricks under the bed.