Latest Research on Bedwetting
There is an abundance of information available to parents about bedwetting in this era of the Internet and instant communication, but it is difficult for non-professionals to make sense of it all. With new studies coming out daily, it's hard to stay on top of the latest health information and understand what may relate to your child.
But according to Dr. Patrick C. Friman, director of behavioral pediatrics at Girls and Boys Town in Nebraska, there isn't much in the way of new information on the topic of bedwetting, so there's less for you to keep up with. However, there are some studies from the past five years or so that just might be of assistance to you and your child.
It's in the Genes
Some of the biggest news, and a big relief to parents, is confirmation through scientific study that bedwetting is not caused by poor parenting or bad discipline. Genetic studies increasingly support the hypothesis that bedwetting runs in families and is involuntary. DNA research by scientists has even identified possible enuresis genes on chromosomes 13 and 22, which would confirm anecdotal evidence of an inherited problem.
In addition, scientists are learning more about the depression and behavioral problems often associated with bedwetting. Once thought to be a cause of enuresis, studies are exploring the idea that mental disorders and bedwetting might simply both be symptoms of the same physical causes: brain chemistry gone awry.
Also important, says Dr. Friman, is the possibility that punitive and guilt-inducing ways a family reacts to a child's bedwetting might cause stress and anxiety that can lead to emotional difficulties.
Studies also confirm the usefulness of alarm systems, especially light and vibration-based alarms. The mechanism by which the alarms do their work is still not fully understood, but it seems to center on subconscious conditioning, a learning process that is going on beneath the level of conscious thought.
Research on the use of medicines in the treatment of bedwetting is still pessimistic. The drugs most commonly used for treatment (imiprimine, desmopressin, oxybutynin) are prescribed as a stopgap measure until bedwetting stops on its own. Except for one study using two drugs simultaneously, these medicines have not been shown to "cure" bedwetting when not in use. In fact, according to a 2002 article in the British Medical Journal, the company that produces desmopressin (ddAVP) was censured in 2002 for "falsely optimistic" statistics on success rates.
Bladder capacity is also a common topic in enuresis research. A study, appearing in the May 2003 issue of the journal, Urology, found that children who wet the bed appear to have smaller bladder capacities at night.
Researchers measured the bladder capacity of children with enuresis both during the day and at night and discovered no difference from their peers in the amount of urine their bladders could hold during the day. At night, however, they found that enuretics' bladder capacity during sleep was significantly smaller than during the day.
Such research, according to Dr. Lane Robson of the National Kidney Foundation's Enuresis Committee, is very important. "In my view, the biggest research advancement in the last five years has been the recognition that many of the children with bedwetting have a bladder that acts small at night," says Dr. Robson. "This has many implications for treatment."
Researchers have also found some success in sharpening children's signals of fullness through an approach that stretches the bladder's capacity through "retention control."
The Subject of Sleep
Much of the popular literature about bedwetting discusses the role of sleep patterns, but there is debate about whether bedwetting should be classified as a "sleep disorder."
One interesting study in the journal, Sleep, in Sweden, concluded that enuretic children do not experience significantly different sleep patterns than their dry peers. They did find, however, that heart rate variability during sleep did differ in enuretics.
There are some interesting approaches on the horizon, many of which are being researched overseas. A study in the United Arab Emirates reports "markedly reduced bedwetting episodes" with the use of indomethacin, a nonsteroidal anti-inflammatory drug. In addition, Japanese researchers have seen a 40 percent improvement in bedwetting after acupuncture treatments, which increased to 47 percent after two months.
Parents seek information from many sources, but ultimately you must use your own best judgment on what advice to take.
"I've looked for [information] on the Internet via Web sites and discussion boards, [from] pediatricians and books on the subject," says a Susie Beck*, a mother of an 8-year-old enuretic in Wisconsin. "I trust my instincts and advice that I feel won't negatively affect my child."