Help for bedwetting: which treatments work best?

By Deborah Kotz, Globe Staff

With a social network of friends who are parents of school-age children like me, I’m amazed that I’ve never had a conversation about bedwetting. One of my friends alluded to it once, I think, when telling me why her 11-year-old never went to sleepovers.

Unlike other topics that friends frequently ask me for information about as a health reporter, I’ve never been asked about bedwetting: what causes it, how to prevent it, and whether it ever resolves on its own. Perhaps it’s just too embarrassing to broach or seen as some sort of failure on the part of the child or parent.

Yet bedwetting -- which becomes a medical condition called nocturnal enuresis after kids reach the age of five -- is far more common that you might think. About 6 percent of boys and 3 percent of girls ages 8 to 11 experience it at least two nights a week, and boys have more severe bedwetting than girls.

Genetics also plays a role: A study published last year in the Journal of Urology found that the odds of a child being a severe bedwetter were nearly four times higher than average if the mother also had a history of bedwetting as a child.

The reasons for why it occurs are usually physiological, not psychological: excessive urine production at night, overactive bladder, and failure to awaken in response to bladder sensations. “Each mechanism can be supported by various studies, and no one theory is likely to explain bedwetting in all children,” wrote Dr. Darcie Kiddoo, a pediatric urologist at the University of Alberta in Edmonton, in a review paper published Monday in the Canadian Medical Association Journal.

So what can be done about it? After ruling out a life stressor like divorce, a new baby, or recent move -- a less common cause of bedwetting -- pediatricians should also check for constipation, spinal malformations, daytime urinary incontinence, or urinary tract infections.

When the diagnosis is simply nocturnal enuresis of unknown cause, treatments may include drugs like demospressin (which reduces urine production) and tricyclic antidepressants. Demospressin is relatively safe and doesn’t have many side effects but provides temporary relief that doesn’t last after the medication is stopped. Tricyclic antidepressants, which cause the brain to respond to bladder sensations, have a host of side effects such as dry mouth and serious risks if given in too high a dose, so they’re only prescribed in extreme cases, according to Kiddoo.

Surprisingly, the treatment found in studies to work best is a nighttime alarm clock set to go off every few hours. A 2005 review study found that using alarm clocks throughout the night could help the brain respond to bladder sensations, even better than medications. After two to four months of using bed alarms, 66 percent of children maintained two weeks of dry nights compared with only 4 percent of children with no treatment. What’s better, the effect lasted even after the alarm was stopped.

The one caveat is that during treatment, parents need to wake up with their kids to make sure they’re rousing with the alarm. Also, bed alarms aren’t ideal for kids who share rooms.

About 15 percent of bedwetters outgrow the habit every year without any treatment whatsoever. That said, parents still need to step in to comfort kids who have this habit. “The most critical aspect of treatment is reassurance for the child, who may experience low self-esteem,” Kiddoo wrote.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.