Just the facts: the latest research on bedwetting to help your child

In this age of the internet and instant communication, parents have more information than ever before about bedwetting, but it's often difficult to know what to believe. With new studies constantly being published, it's hard to stay up-to-date on the latest health information and understand what applies to your child. Here are a few studies from the last five years or so that Dr. Patrick C. Friman, director of behavioral pediatrics at Girls and Boys Town in Nebraska, says are likely to help you and your child.

It's in the genes

One of the biggest pieces of news, which is also a relief for parents, is the scientific confirmation that bedwetting is not attributable to poor parenting or inadequate discipline. Genetic studies increasingly support the hypothesis that bedwetting is hereditary and involuntary. DNA research has identified genes that could be responsible for bedwetting on chromosomes 13 and 22, which would confirm the empirical evidence of a hereditary component. Dr. Friman also discusses the very real possibility that punitive and guilt-inducing family reactions to a child's bedwetting can be a source of stress and anxiety, potentially leading to emotional distress.

Medically speaking

Research on the use of medication to treat bedwetting remains pessimistic. The most commonly used medications (imipramine, desmopressin, oxybutynin) are prescribed as palliative measures until bedwetting resolves on its own. With the exception of one study using two medications simultaneously, there has been no evidence that these drugs "cure" bedwetting. In fact, according to a 2002 article in the British Medical Journal, the company that produces desmopressin (ddAVP) was publicly reprimanded that same year for presenting "falsely optimistic" statistics on success rates.

On a physical level

Bladder capacity is also a common topic in enuresis research. A study published in the May 2003 issue of the journal Urology revealed that the bladders of bedwetting children appear to have reduced capacity at night. Researchers measured the daytime and nighttime bladder capacity of children with enuresis and found no difference compared to their peers in the amount of urine their bladders could hold during the day. They also found that at night, however, the bladder capacity of enuresis patients was significantly less than their daytime capacity.

According to Dr. Lane Robson of the National Kidney Foundation's Enuresis Committee, such research is very important. "In my opinion, the biggest advance in research over the past five years has been the recognition that many children with bedwetting have a reduced bladder capacity at night," says Dr. Robson. "This affects treatment in several ways." Many experts also believe that wearing disposable underwear does not delay a child's ability to become continent. "Many of our patients wear disposable underwear at night for comfort," says Dr. Ritchey, a pediatric urologist at Hermann Hospital in Houston, Texas. "I don't find that they respond any differently to treatment compared to children who continue to wet the bed."

Researchers have also achieved some success in intensifying the signal in children that the bladder is full by an approach aimed at stretching the bladder to its full capacity through "retention control".

On the subject of sleep

Much of the popular literature on bedwetting discusses the role of sleep structure, but there is still disagreement as to whether bedwetting should be classified as a "sleep disorder." An interesting study published in the Swedish journal Sleep concluded that the sleep structure of children who wet the bed does not differ significantly from that of their non-wetting peers. However, it was found that heart rate during sleep is different in children who wet the bed.

Alternative approaches

There are some promising approaches on the horizon, many of which are being researched abroad. A study conducted in the United Arab Emirates reports "a marked decrease in bedwetting episodes" when using indomethacin, a nonsteroidal anti-inflammatory drug. Additionally, Japanese researchers observed a 40% improvement in bedwetting following acupuncture treatments, increasing to 47% after two months. These approaches, however, should only be considered after consulting a medical expert or physician.

Parents gather information from many sources. But ultimately, they must use their judgment to decide which advice to follow. “I’ve looked for information on the internet, on websites and forums, from pediatricians, and in books on the subject,” says Susie*, a mother of an 8-year-old in Wisconsin. “I trust my instincts and the advice that I believe won’t have negative effects on my child.”