Bedwetting
Hannah Putney, a Pediatric Nurse Practioner, discusses what causes bedwetting in adolescents and what to do to prevent it.
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Learn more about Hannah Puntney, APRN
Hannah Puntney, APRN
Hannah Puntney, APRN is a pediatric nurse practitioner for pediatric urology at UK HealthCare.Learn more about Hannah Puntney, APRN
Transcription:
Bedwetting
Joey Wahler: Nocturnal enuresis, commonly called bedwetting, is a common problem for young children, but the causes and remedies aren't as complicated as you might think.
This is UK. HealthCast a podcast from UK healthcare. Thanks for listening. I'm Joey.
Our guest, Dr. Hannah Puntney, pediatric nurse practitioner, specializing in pediatric urology at UK HealthCare. Dr. Puntney, thanks for joining us.
Dr. Hannah Puntney: Thank you.
Joey Wahler: So first in a nutshell, what typically causes bedwetting in the first place?
Dr. Hannah Puntney: There are a number of different causes. And it kind of depends on the type of bedwetting you're talking about. There are two different types. You can have primary bedwetting or primary nocturnal enuresis and then secondary nocturnal enuresis. Primary can be caused by a family history. It could be gender. Men or boys tend to be a little bit more prone to bedwetting than women. It could be a lack of hormone that we produce at night called vasopressin. It could be just as simple as a small bladder size or a lack of communication between the brain and the bladder. And then, secondary bedwetting is when a child has been dry at night for a period greater than six months. And then, all of a sudden started bedwetting. So a lot of times that can be caused by a stressor, you know, a stressful event or there could be a physiologic problem going on like constipation, diabetes, sleep apnea, UTIs, things like that.
Joey Wahler: Gotcha. So what's considered "normal bedwetting" and when does it become a more concerning issue?
Dr. Hannah Puntney: So it kind of depends on the families that we see. You know, one of the things I mentioned that causes primary bedwetting is family history. So, we know that if one parent was a bedwetter, their offspring are 50% likely to have bed wedding. And then, if both parents were bedwetters, they are 75% likely that their offspring will have bedwetting. So sometimes, you know, if the mom or dad bed-wet until they were 10 or 11, they don't really see it a problem until their child has exceeded that timeframe. So it kind of seems to be family-specific. We kind of base it on averages. The majority of kids between the ages of five to six, 15% to 20% of kids bed-wet So that's still pretty common. When you get closer to the age of 10, about 10% of kids bed wet. Then after the age of 15, only about 1% of adolescents have bedwetting. So it's hard to say what's normal, what's not normal. You know, we just kind of know what ranges are normal in percentages.
Joey Wahler: So at what age, if it persists, would it be a big concern?
Dr. Hannah Puntney: Again, I think it kind of depends on the family and if it is interfering with the child's social situation or not, if it's interfering with sleepovers or school functions. You know, it's not necessarily normal versus abnormal. We know that most kids or adolescents will outgrow it with time. And our job is just to try to make that happen a little bit sooner. But, you know, I would say most providers don't get too excited about treating it until they're closer to the age of seven or even closer to the age of 10.
Joey Wahler: Gotcha. Now, before we talk about treatment, what are some tips to help prevent bedwetting in most children on your own, meaning on the part of either the child and/or the parents?
Dr. Hannah Puntney: Easy stuff, making sure they're peeing regularly during the day. We try to shoot for peeing five to eight times daily. Making sure that they're drinking plenty of fluids kind of towards the beginning part of the day. And then, you can kind of limit that an hour or two before bedtime. Sometimes our families think it's silly that we want them to drink a certain amount during the beginning part of the day. But drinking water is one of the things that kind of helps the bladder grow. The more we use it, the more urine it has to hold, the more the bladder increases its capacity. Making sure we're staying away from like caffeine, carbonation, artificial coloring, sugary drinks. In some kids, that can be irritating and then, also monitoring for bowel movements, making sure that the child doesn't have issues with constipation. And that can be a tricky thing. Some kids can be having a bowel movement every day, but it's maybe only a small bowel movement and they're not fully passing everything. And that can put pressure on the bladder over time and decrease the bladder's capacity.
Joey Wahler: Interesting. So one end, so to speak, can affect the other sometimes.
Dr. Hannah Puntney: Absolutely.
Joey Wahler: So if all else fails, at what point normally should professional help be sought for a bedwetting issue?
Dr. Hannah Puntney: So I think it kind of is family specific and when it starts to interfere with that child's life. But if they are, you know, seven or eight or 10, and they're wanting to have a sleepover or they're wanting to go on a family vacation and, you know, don't to want worry about having an accident at the Airbnb or something like that. You know, that's typically when we start to get involved,
Joey Wahler: And if you do get involved, when you get involved, what type of help does a doctor or do medical professionals offer?
Dr. Hannah Puntney: The biggest thing is just a thorough history and physical exam to kind of rule out any of those other physiologic causes that we talked about earlier. And talking with the family, educating, you know, kind of why it happens, what conservative things could we do to kind of prevent it. And then, we can talk about treatment options for management. So, the gold standard of treatment for bedwetting is something called a bedwetting alarm. And this is something that families can purchase on their own. They range from inexpensive to really expensive. And I usually tell my families to err on the side of not spending too much money on them, because it's a pretty simple device. It's a kind of a clip that connects to their underwear. And at the first drop of urine, this loud alarm goes off. And with time, it's kind of like a Pavlovian response. If you remember Pavlov's dog where, you know, they would ring a bell and feed the dogs and then eventually with no food present, ring a bell and the dogs would salivate. So the bell is ringing or the alarm is going off every time a child has had an accident. And prior to that, they've had 10 to 15 minutes or so of that full bladder sensation. And with time and consistency, you can start to train the bladder to associate that full bladder sensation with the anticipation of the alarm. And then with time, the child starts to wake up sometimes mid-void, so they've already had the accident. The alarm has gone off, but they wake up very quickly and then, you know, hopefully, eventually, they'll wake up dry in anticipation of the alarm going off.
Joey Wahler: So that method kind of head off the worst of it then, right?
Dr. Hannah Puntney: Sure. And it can just train the child to wake up in the middle of the night. We kind of trade one problem for another. So you trade the bedwetting or the nocturnal enuresis for what we call nocturia or waking at night to pee. Typically, bedwetters are deep sleepers. And so even if they're waking up in the middle of the night, they usually can fall back pretty quickly. You know, if they do get up to go to the bathroom, they can fall back pretty quickly and it's not very disruptive to their sleep.
Joey Wahler: How important then is just building a child's self-esteem and working with them a bit on the emotional side, so they realize the problem isn't their fault?
Dr. Hannah Puntney: Oh, that's so important. You know, and I think a lot of times, especially when family members have dealt with it when they were children, I think they tend to be a little bit more empathetic. I think it's a little bit harder when the parent maybe didn't go through that as a child and didn't experience that. You know, I think that's a lot of times the take-home, I try to educate our families is that this child is not doing this on purpose. This is not something they want to happen. If they could control it, they would just, you know, wake up in the middle of the night or hold their pee all night. So yeah, understanding that, you know, any punishment or anything like that is not going to be helpful. And in some cases, it can kind of worsen it or postpone their progress. So really getting everybody on board that this is not something that the child can control, but maybe there's some behavioral things we can change. And then, there's also an option of medicine as well, that can kind of help to decrease urine end production at night.
Joey Wahler: And speaking of not wanting to worsen things. How about the fact that if left untreated, am I right, bedwetting can cause a urinary tract infection?
Dr. Hannah Puntney: I guess if the child is left wet, you know, if they are sitting in wet underwear, just like if they're having accidents during the day and that area is always wet, that could perhaps make them a little bit more prone or give the bacteria something to kind of move on. But, in my experience, typically it doesn't cause UTIs. It can cause skin breakdown, rashes, things like that, but not to get bacteria in the bladder.
Joey Wahler: So is it safe to say in your opinion then that while bedwetting isn't something to be taken lightly, often it seems worse than it really is?
Dr. Hannah Puntney: Absolutely. And I always tell families, you know, "I'm not the one that's at your home dealing with the repercussions of these accidents. I'm not the one doing the laundry and changing sheets and dealing with an upset child in the morning after the night of an accident." But that is the biggest, effect, I guess, of the bedwetting, is it can be difficult for the child, frustrating for the child upsetting for the child. And so trying to get everybody on the same page that, you know, this is something that we're all going to work together to try to do our best. You know, again, make those daytime changes that we can to kind of set them up for success at night. And then just time, giving it time and being patient with the child, I think that can be super helpful for them.
Joey Wahler: Understood. Well, folks, we trust you're now more familiar with addressing your child's bedwetting, Dr. Hannah Puntney. Thanks so much again.
Dr. Hannah Puntney: Thank you.
Joey Wahler: And for more information, please visit the Kentucky Children's Hospital website or call 859-323-6211. Again, 859-323-6211. If you found this podcast helpful, please share it on your social media. And thanks for listening to UK. HealthCast a podcast from UK healthcare, hoping your health is good health. I'm Joey Waller.
Bedwetting
Joey Wahler: Nocturnal enuresis, commonly called bedwetting, is a common problem for young children, but the causes and remedies aren't as complicated as you might think.
This is UK. HealthCast a podcast from UK healthcare. Thanks for listening. I'm Joey.
Our guest, Dr. Hannah Puntney, pediatric nurse practitioner, specializing in pediatric urology at UK HealthCare. Dr. Puntney, thanks for joining us.
Dr. Hannah Puntney: Thank you.
Joey Wahler: So first in a nutshell, what typically causes bedwetting in the first place?
Dr. Hannah Puntney: There are a number of different causes. And it kind of depends on the type of bedwetting you're talking about. There are two different types. You can have primary bedwetting or primary nocturnal enuresis and then secondary nocturnal enuresis. Primary can be caused by a family history. It could be gender. Men or boys tend to be a little bit more prone to bedwetting than women. It could be a lack of hormone that we produce at night called vasopressin. It could be just as simple as a small bladder size or a lack of communication between the brain and the bladder. And then, secondary bedwetting is when a child has been dry at night for a period greater than six months. And then, all of a sudden started bedwetting. So a lot of times that can be caused by a stressor, you know, a stressful event or there could be a physiologic problem going on like constipation, diabetes, sleep apnea, UTIs, things like that.
Joey Wahler: Gotcha. So what's considered "normal bedwetting" and when does it become a more concerning issue?
Dr. Hannah Puntney: So it kind of depends on the families that we see. You know, one of the things I mentioned that causes primary bedwetting is family history. So, we know that if one parent was a bedwetter, their offspring are 50% likely to have bed wedding. And then, if both parents were bedwetters, they are 75% likely that their offspring will have bedwetting. So sometimes, you know, if the mom or dad bed-wet until they were 10 or 11, they don't really see it a problem until their child has exceeded that timeframe. So it kind of seems to be family-specific. We kind of base it on averages. The majority of kids between the ages of five to six, 15% to 20% of kids bed-wet So that's still pretty common. When you get closer to the age of 10, about 10% of kids bed wet. Then after the age of 15, only about 1% of adolescents have bedwetting. So it's hard to say what's normal, what's not normal. You know, we just kind of know what ranges are normal in percentages.
Joey Wahler: So at what age, if it persists, would it be a big concern?
Dr. Hannah Puntney: Again, I think it kind of depends on the family and if it is interfering with the child's social situation or not, if it's interfering with sleepovers or school functions. You know, it's not necessarily normal versus abnormal. We know that most kids or adolescents will outgrow it with time. And our job is just to try to make that happen a little bit sooner. But, you know, I would say most providers don't get too excited about treating it until they're closer to the age of seven or even closer to the age of 10.
Joey Wahler: Gotcha. Now, before we talk about treatment, what are some tips to help prevent bedwetting in most children on your own, meaning on the part of either the child and/or the parents?
Dr. Hannah Puntney: Easy stuff, making sure they're peeing regularly during the day. We try to shoot for peeing five to eight times daily. Making sure that they're drinking plenty of fluids kind of towards the beginning part of the day. And then, you can kind of limit that an hour or two before bedtime. Sometimes our families think it's silly that we want them to drink a certain amount during the beginning part of the day. But drinking water is one of the things that kind of helps the bladder grow. The more we use it, the more urine it has to hold, the more the bladder increases its capacity. Making sure we're staying away from like caffeine, carbonation, artificial coloring, sugary drinks. In some kids, that can be irritating and then, also monitoring for bowel movements, making sure that the child doesn't have issues with constipation. And that can be a tricky thing. Some kids can be having a bowel movement every day, but it's maybe only a small bowel movement and they're not fully passing everything. And that can put pressure on the bladder over time and decrease the bladder's capacity.
Joey Wahler: Interesting. So one end, so to speak, can affect the other sometimes.
Dr. Hannah Puntney: Absolutely.
Joey Wahler: So if all else fails, at what point normally should professional help be sought for a bedwetting issue?
Dr. Hannah Puntney: So I think it kind of is family specific and when it starts to interfere with that child's life. But if they are, you know, seven or eight or 10, and they're wanting to have a sleepover or they're wanting to go on a family vacation and, you know, don't to want worry about having an accident at the Airbnb or something like that. You know, that's typically when we start to get involved,
Joey Wahler: And if you do get involved, when you get involved, what type of help does a doctor or do medical professionals offer?
Dr. Hannah Puntney: The biggest thing is just a thorough history and physical exam to kind of rule out any of those other physiologic causes that we talked about earlier. And talking with the family, educating, you know, kind of why it happens, what conservative things could we do to kind of prevent it. And then, we can talk about treatment options for management. So, the gold standard of treatment for bedwetting is something called a bedwetting alarm. And this is something that families can purchase on their own. They range from inexpensive to really expensive. And I usually tell my families to err on the side of not spending too much money on them, because it's a pretty simple device. It's a kind of a clip that connects to their underwear. And at the first drop of urine, this loud alarm goes off. And with time, it's kind of like a Pavlovian response. If you remember Pavlov's dog where, you know, they would ring a bell and feed the dogs and then eventually with no food present, ring a bell and the dogs would salivate. So the bell is ringing or the alarm is going off every time a child has had an accident. And prior to that, they've had 10 to 15 minutes or so of that full bladder sensation. And with time and consistency, you can start to train the bladder to associate that full bladder sensation with the anticipation of the alarm. And then with time, the child starts to wake up sometimes mid-void, so they've already had the accident. The alarm has gone off, but they wake up very quickly and then, you know, hopefully, eventually, they'll wake up dry in anticipation of the alarm going off.
Joey Wahler: So that method kind of head off the worst of it then, right?
Dr. Hannah Puntney: Sure. And it can just train the child to wake up in the middle of the night. We kind of trade one problem for another. So you trade the bedwetting or the nocturnal enuresis for what we call nocturia or waking at night to pee. Typically, bedwetters are deep sleepers. And so even if they're waking up in the middle of the night, they usually can fall back pretty quickly. You know, if they do get up to go to the bathroom, they can fall back pretty quickly and it's not very disruptive to their sleep.
Joey Wahler: How important then is just building a child's self-esteem and working with them a bit on the emotional side, so they realize the problem isn't their fault?
Dr. Hannah Puntney: Oh, that's so important. You know, and I think a lot of times, especially when family members have dealt with it when they were children, I think they tend to be a little bit more empathetic. I think it's a little bit harder when the parent maybe didn't go through that as a child and didn't experience that. You know, I think that's a lot of times the take-home, I try to educate our families is that this child is not doing this on purpose. This is not something they want to happen. If they could control it, they would just, you know, wake up in the middle of the night or hold their pee all night. So yeah, understanding that, you know, any punishment or anything like that is not going to be helpful. And in some cases, it can kind of worsen it or postpone their progress. So really getting everybody on board that this is not something that the child can control, but maybe there's some behavioral things we can change. And then, there's also an option of medicine as well, that can kind of help to decrease urine end production at night.
Joey Wahler: And speaking of not wanting to worsen things. How about the fact that if left untreated, am I right, bedwetting can cause a urinary tract infection?
Dr. Hannah Puntney: I guess if the child is left wet, you know, if they are sitting in wet underwear, just like if they're having accidents during the day and that area is always wet, that could perhaps make them a little bit more prone or give the bacteria something to kind of move on. But, in my experience, typically it doesn't cause UTIs. It can cause skin breakdown, rashes, things like that, but not to get bacteria in the bladder.
Joey Wahler: So is it safe to say in your opinion then that while bedwetting isn't something to be taken lightly, often it seems worse than it really is?
Dr. Hannah Puntney: Absolutely. And I always tell families, you know, "I'm not the one that's at your home dealing with the repercussions of these accidents. I'm not the one doing the laundry and changing sheets and dealing with an upset child in the morning after the night of an accident." But that is the biggest, effect, I guess, of the bedwetting, is it can be difficult for the child, frustrating for the child upsetting for the child. And so trying to get everybody on the same page that, you know, this is something that we're all going to work together to try to do our best. You know, again, make those daytime changes that we can to kind of set them up for success at night. And then just time, giving it time and being patient with the child, I think that can be super helpful for them.
Joey Wahler: Understood. Well, folks, we trust you're now more familiar with addressing your child's bedwetting, Dr. Hannah Puntney. Thanks so much again.
Dr. Hannah Puntney: Thank you.
Joey Wahler: And for more information, please visit the Kentucky Children's Hospital website or call 859-323-6211. Again, 859-323-6211. If you found this podcast helpful, please share it on your social media. And thanks for listening to UK. HealthCast a podcast from UK healthcare, hoping your health is good health. I'm Joey Waller.