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                    Urologic Diseases
                    Bladder Control Problems & Bedwetting in Children
                    Treatment

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        Bladder Control Problems & Bedwetting in Children
        Definition & Facts
                Symptoms & Causes
                Diagnosis
                Treatment
                Prevention
                Clinical TrialsTreatment of Bladder Control Problems & Bedwetting in Children
How can my child’s doctor and I treat a bladder control problem?
When a health condition causes the wetting—such as diabetes or a birth defect in the urinary tract—doctors will treat the health problem, and the wetting is likely to stop.
Other common treatments for wetting include bladder training, moisture alarms, medicines, and home care. Teamwork is important among you, your child, and your child’s doctor. You should reward your child for following a program, rather than for staying dry—because a child often cannot control wetting.
If your child wets both day and night, the doctor is likely to treat daytime wetting first. Children usually stay dry during the day before they gain bladder control at night.
Daytime wetting
Treatments for daytime wetting depend on what’s causing the wetting, and will often start with changes in bladder and bowel habits. Your child’s doctor will treat any constipation, so that hard stools don’t press against the bladder and lead to wetting.
Bladder training
Bladder training helps your child get to the bathroom sooner and may help reset bladder systems that don’t work together smoothly. Programs can include
urinating on schedule every 2 to 3 hours, called timed voiding.
    urinating twice during one visit, called double voiding. This method may help the bladder empty completely in children who have an underactive or “lazy” bladder or vesicoureteral reflux (VUR)
    relaxing the pelvic floor muscles so children can empty the bladder fully. A few sessions of biofeedback can retrain muscles that don’t work together in the right order.In extremely rare cases, doctors may suggest using a thin, flexible tube, called a catheter, to empty the bladder. Occasional use of a catheter may help develop better bladder control in children with a weak, underactive bladder.
Medicine
Your child’s doctor may suggest medicine to limit daytime wetting or prevent a urinary tract infection (UTI).
Oxybutynin (Ditropan) is often the first choice of medicine to calm an overactive bladder until a child matures and outgrows the problem naturally.
If your child often has bladder infections, the doctor may prescribe an antibiotic, which is a medicine that kills the bacteria that cause infections. Your child’s doctor may suggest taking a low-dose antibiotic for several months to prevent repeated bladder infections.
Home care and support
Changes in your child’s routines and behavior may greatly improve daytime wetting, even without other treatments. Encourage your child to
use the bathroom whenever the urge occurs.
    drink more liquid, mainly water, if the doctor suggests doing so. Drinking more liquid produces more urine and more trips to the bathroom.
    take extra time in the bathroom to relax and empty the bladder completely.
    avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.Children need plenty of support from parents and caregivers to overcome daytime wetting, not blame or punishment. Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.
Bedwetting
If your child’s provider suggests treatment, it’s likely to start with ways to motivate your child and change his or her behavior. The next steps include moisture alarms or medicine.
For a bedwetting treatment program to work, both the parent and child must be motivated. Treatment doesn’t always completely stop bedwetting—and there are likely to be some setbacks. However, treatment can greatly reduce how often your child wets the bed.
Motivational therapy
For motivational therapy, you and your child agree on ways to manage bedwetting and rewards for following the program. Keep a record of your child’s tasks and progress, such as a calendar with stickers. You can give rewards to your child for remembering to use the bathroom before bed, helping to change and clean wet bedding, and having a dry night.
Motivational therapy helps children gain a sense of control over bedwetting. Many children learn to stay dry with this approach, and many others have fewer wet nights. Taking back rewards, shaming, penalties, and punishments don’t work; your child is not wetting the bed on purpose.  If there’s no change in your child’s wetting after 3 to 6 months, talk with a health care professional about other treatments.
Health care professional places a sticker on the shirt of a little girl who is sitting on an examining table.Tracking good bathroom habits may help children develop fewer wet days or nights over time. Rewards are given for effort, because a child can’t always control wetting.Moisture alarms
Moisture alarms detect the first drops of urine in a child’s underwear and sound an alarm to wake the child. A sensor clips to your child’s clothes or bedding. At first you may need to wake your child, get him or her to the bathroom, and clean up wet clothes and bedding. Eventually, your child learns to wake up when his or her bladder is full and get to the bathroom in time.
Moisture alarms work well for many children and can end bedwetting for good. Families need to use the alarm regularly for 3 to 4 months as the child learns to sense his or her signals and control the bladder. Signs of progress usually appear in the first few weeks—smaller wet spots, fewer alarms each night, and your child waking on his or her own.
Medicine
Your child’s doctor may suggest medicine when other treatments haven’t worked well.
Desmopressin (DDAVP) is often the first choice of medicine for bedwetting. This medicine slows the amount of urine your child’s body makes overnight, so the bladder doesn’t overfill and leak. Desmopressin can work well, but bedwetting often returns when a child stops taking the medicine. You can use desmopressin for sleepovers, camp, and other short periods of time.  You can also keep a child on desmopressin safely for long periods of time.
Home care
Changes in your child’s routines may improve bedwetting, when used alone or with other treatments. Encourage your child to
drink most of his or her liquids during the morning and early afternoon.
    urinate regularly during the day—every 2 to 3 hours—and just before bed, which is a total of about 4 to 7 times a day.
    urinate twice before bedtime (about a half hour apart) to fully empty the bladder and allow room for new urine made overnight.
    avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.View from a hallway shows a girl washing her hands in a bathroom next to her bedroom.Children who wet the bed should use the bathroom just before bedtime.How can I help my child cope with bladder control problems?
Your patience, understanding, and encouragement are vital to help your child cope with a bladder control problem. If you think a health problem may be causing your child’s wetting, make an appointment with your child’s health care provider.
Clothing, bedding, and wearable products
For children with daytime wetting, clothes that come on and off easily may help prevent accidents. A wristwatch alarm set to vibrate can privately remind your child to visit the toilet, without help from a teacher or parent.
For children who wet the bed, the following practices can make life easier and may boost your child’s confidence:
Leave out dry pajamas and towels so your child can clean up easily.
    Layer waterproof pads and fitted sheets on the bed. Your child can quickly pull off wet bedding and put it in a hamper. Fewer signs of wetting may help your child feel less embarrassed.
    Have your child help with the clean-up and laundry the next day. However, don’t make it a punishment.
    Be sure your child showers or bathes every day to wash away the smell of urine.
    Plan to stop using diapers, training pants, or disposable training pants, except when sleeping away from home. These items may discourage your child from getting out of bed to use the toilet.Don’t make a habit of waking your child during the night to use the bathroom. Researchers don’t think it helps children overcome bedwetting.3
Father and son work together to put dirty laundry into a washing machine.Easy clean-up routines may give children a sense of control while they outgrow bedwetting.Emotional support
Let your child know that bedwetting is very common and most children outgrow it. If your child is age 4 or older, ask him or her for ideas on how to stop or manage the wetting. Involving your child in finding solutions may provide a sense of control.
Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.
References
[3] Tu ND, Baskin LS. Nocturnal enuresis in children: management. UptoDate website. https://www.uptodate.com/contents/nocturnal-enuresis-in-children-management. Updated June 14, 2017. Accessed August 22, 2017.        Last Reviewed September 2017
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