INTRODUCTION Soggy sheets and pajamas, a stained mattress and a bad-smelling room \u2013 and an embarrassed child \u2013 are familiar scenes in many homes.\u00a0 But do not despair.\u00a0 Bet-wetting, or nocturnal eneuresis, is not a sign of toilet training gone bad.\u00a0 It\u2019s often a normal part of development. It is also know as nighttime incontinence.\u00a0 Primary eneuresis is the term used to describe children who have never been dry at night.\u00a0 Children who begin to wet the bed after at least six months of dry nights are said to have secondary eneuresis. Generally, eneuresis before age 6 or 7 isn\u2019t cause for concern.\u00a0 At this age, nighttime bladder control simply may not be established. If bed-wetting continues, treat the problem with patience and understanding.\u00a0 Bladder training, medication, or moisture alarms may help. SIGNS AND SYMPTOMS Simply, bed-wetting is characterized by involuntary urination at night.\u00a0 Note the word \u2018involuntary;\u2019 the child is not doing it on purpose. Most kids are toilet-trained between the ages 2 and 4 \u2013 but there\u2019s no target date for developing complete bladder control.\u00a0 At age 3, about 40 percent of children still wet the bed, and at age 5, about 20 percent still do, at least occasionally. WHAT ARE THE CAUSES OF BED-WETTING? No one knows for sure, but various factors play a role. Inability to recognize a full bladder.\u00a0 If the nerves that control the bladder are slow to mature, a full bladder may not rouse a child from sleep, especially if the child happens to be a deep sleeper. A small bladder.\u00a0 Your child\u2019s bladder may not be developed enough to hold urine that\u2019s produced during the night.\u00a0 This is especially why it is important for kids who have the problem not to drink water or fluids too soon before bed. Stress.\u00a0 Stressful events such as starting a new school, sleeping away from home or getting a new brother or sister, may trigger bed-wetting. A hormone imbalance.\u00a0 During childhood, some kids don\u2019t produce enough anti-diuretic hormone, ADH, to slow nighttime urine production. Urinary tract infection.\u00a0 An infection in the urinary tract (kidney to urethra) can make it difficult for your child to control urination.\u00a0 Bed-wetting may be accompanied by frequent (daytime) urination and pain during the process. Sleep apnea.\u00a0 Sometimes a child\u2019s breathing is interrupted during sleep, and bed-wetting can actually be a sign of this.\u00a0 Apnea can result from enlarged or inflamed tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, and daytime drowsiness.\u00a0 Teachers, look out for this at school. Diabetes. For a child who is usually dry at night, eneuresis may be a sign of type1, or Juvenile onset (insulin-dependent) diabetes.\u00a0 Other signs and symptoms may include unusual thirst, fatigue, and weight loss in spite of a good appetite.\u00a0 Passing large amounts of urine at once is also a sign.\u00a0 (These are the classic: polydipsia, polyphagia, and polyuria). Chronic constipation.\u00a0 Some kids who don\u2019t pass stools regularly retain urine as well, leading to nocturnal eneuresis. Anatomical defect.\u00a0 On a rare occasion, bed-wetting is due to a defect in the child\u2019s urinary system. ANY RISK FACTORS? Bed-wetting can affect anyone, but it\u2019s twice as common in boys.\u00a0 It also tends to run in the family.\u00a0 A child with both parents who wet the bed has an 80 percent chance of wetting the bed, too. WHEN TO SEE THE DOC Most kids outgrow is problem on their own, but some need a little help.\u00a0 In other cases, eneuresis may indicate an underlying condition that needs medical attention. See the doc if: \u2022\u00a0\u00a0\u00a0 Your child still wets the bed after age 5 or 6. \u2022\u00a0\u00a0\u00a0 Your child starts to wet the bed after a period of being dry at night. \u2022\u00a0\u00a0\u00a0 Bed-wetting is accompanied by painful urination, unusual thirst, pink urine, or snoring. SCREENING AND DIAGNOSIS Doc will ask questions (nothing new here) about the history of your child\u2019s health and bed-wetting pattern.\u00a0 For instance: \u2022\u00a0\u00a0\u00a0 Is there a family history of bet-wetting? \u2022\u00a0\u00a0\u00a0 Did your child always wet the bed, or did it begin recently? \u2022\u00a0\u00a0\u00a0 How often does your child wet the bed? \u2022\u00a0\u00a0\u00a0 Does the problem seem to be triggered by certain foods, drinks, or activities? \u2022\u00a0\u00a0\u00a0 Is your child dry during the day? \u2022\u00a0\u00a0\u00a0 Is the child undergoing any major life changes or other stresses? \u2022\u00a0\u00a0\u00a0 Does the child experience pain or other symptoms when urinating? Of course, doc will examine the child.\u00a0 Urine tests may be done to check for any indication of infection or diabetes.\u00a0 If an anatomical abnormality is suspected, X-Rays or other imaging study of the kidneys or bladder may be needed. ANY COMPLICATIONS? No health risks result from bed-wetting.\u00a0 The guilt and embarrassment a child may feel about wetting may, however, lead to low self-esteem. Rashes on the bottom and genital area may also be an issue, especially if your child sleeps in wet underwear.\u00a0 To prevent a rash, help you child rinse these body areas every morning. Covering the affected area lightly with a petroleum ointment at bedtime may also help. HOW IS BED-WETTING TREATED? As we said before, most kids outgrow it on their own.\u00a0 Limiting fluids before bedtime and double voiding \u2013 urinating at the start of the bedtime routine and then again just before falling asleep \u2013 may help. Encourage your child to delay daytime urination as well.\u00a0 If the bladder isn\u2019t completely full, the urge to urinate may disappear within a few minutes.\u00a0 With practice this simple \u201cstretching exercise\u201d may help your child\u2019s bladder hold more urine at night. If the child is still wetting by age 7 \u2013 and is motivated to stop \u2013 doctor may recommend more aggressive treatment. Moisture alarms. These battery-operated devices connect to a moisture-sensitive pad on your child\u2019s pajamas or bedding.\u00a0 When the pad senses wetness, the alarm goes off. If you try this, give it a lot of time.\u00a0 You may need two weeks to see any response and up to 12 weeks to enjoy dry nights. Medication This is used if all else fails.\u00a0 Among the ones used are: \u2022\u00a0\u00a0\u00a0 Desmopressin \u2013 This causes the body to make less urine at night. \u2022\u00a0\u00a0\u00a0 Imipramine \u2013 This changes the child\u2019s sleeping and waking pattern.\u00a0 It also increases the amount of time a child can hold his urine, and also reduces the amount of urine produced. \u2022\u00a0\u00a0\u00a0 Oxybutinin (Ditropan) \u2013 For a small bladder.\u00a0 This reduces bladder contraction and increases the capacity. Medication helps up to 70 percent of wetters.\u00a0 No guarantees however, even when a combination of medications is used.\u00a0 And wetting often resumes when medication is stopped. ALTERNATIVE THERAPIES Massage, acupuncture, and hypnosis have been said to be effective, but more research is needed to confirm this. Drop me a note if you need some help in coping skills. See you next week. Dr. Emanuel, based in the Commonwealth of Dominica, has been an educator of medical professionals, in training and the public, for over 20 years.