Children's Health: Beating the Bed-wetting Blues (cont.)

What are some of the reasons that a child might wet his pants during the day? Certainly again, you want to rule out the possibility of a medical problem causing it. Assuming that's not true, there are a number of possible causes. One is the child's attention span -- some children are very easily distracted and do not pay attention to the sensation of a full bladder. They continue to play and then finally when they have the urge to go, it's too late to hold it in because they didn't respond when the initial feelings occurred.

Other children may have what's called a small functional capacity -- this means that the bladder is a normal size but for some reason when they get a certain amount of urine in it, they get an incredible urge to pee, much more than another child might have. This doesn't give them the time to make it to the bathroom and avoid wetting their pants.

There can be other causes which are less common such as constipation, when the bowels are so full this pushes on the bladder and causes the child not to be able to hold in his or her urine.

There are much rarer causes with problems where the anatomy of the urinary system is "off" and the urine goes directly to the vagina or penis rather than into the bladder, but those are rare.

I do want to mention one cause of daytime wetness in girls many of you should be aware of because I have seen it quite commonly. It's called vaginal reflux. This occurs often in chubby girls who have wet panties throughout the day. They have no idea they are going and the urine just seems to be dribbling out. What's happening in this case is that when they are sitting on the toilet and peeing, the urine bounces off their thighs and back into the vagina without their knowing. Then during the day the urine simply dribbles out of the vagina slowly and they have no sense of having to go. This is actually a fairly common and easily controlled cause of daytime wetting in some girls. The treatment is quite simple -- it's to make sure that the little girl understands what's going on. Sometimes facing backwards on the toilet so her legs remain spread and she watches the pee go into the toilet, assures that the vaginal reflux does not occur. If you have a little girl with this problem of daytime wetting, think about vaginal reflux also.

My 9-year-old son is diagnosed with ADHD. Part of the evaluation asked if there was any bed-wetting, and yes, he used to wet the bed. Talking with other parents whose children have ADHD, I have found that many of them also wet the bed. Is there a connection between bed-wetting and ADHD?

Not that I know of. Many children with ADHD, as I mentioned, can have a daytime problem because they don't pay attention to the sensation of having to pee and have that problem. But I'm not aware of any evidence that shows children with ADHD are more or less likely to have bed-wetting at night.

Dr. Parker, do you have any other tips to share to help us with the bed-wetting blues?

There's a tip that I've learned through the years that can be helpful. As I mentioned before, bed-wetting is no fun for the family who has to get up at night and is understandably angry at the child for disrupting everybody's sleep. I like to recommend what I call the double-bubble technique to diffuse family tensions and to allow the child to take care of his or her own wet pajamas and sheets at night without involving the rest of the family so everybody can get a good night's sleep.

"Know just that this too will pass, and your child will stop wetting the bed at some point."

The double bubble involves putting the sheets and blanket on the bed covered by a plastic liner, covered again by a new set of sheets and blanket. The child gets into the top set of sheets and blanket and has an extra spare pair of pajamas at the bedside. You teach him or her that if he wets the bed at night and wants to change, he can take care of it himself by pulling off the top layer of the sheets and plastic liner, putting on a new pajamas, and cozying into the new nice warm dry sheets underneath. This way the child can take care of the issue, the parents don't have to get up, everybody gets a good night's sleep, and family relations are restored. Think of the double-bubble technique if this has been an issue for you.

Dr. Parker, we're about out of time for today. Do you have any final words for us?

Know just that this too will pass, and your child will stop wetting the bed at some point. As I said before, the important thing is how you deal with it and how it affects your relationship with your child over time. I have hopefully given you some strategies that will help and may even cure the bed-wetting, but they may not. It may be something that you will have to learn to live with until it mysteriously fades on its own.

I hope I have given you some hope and reason to think that there are things to do and some perspective about when and when not to treat this really common occurrence.

Thank you Dr. Parker.

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