Bedwetting

In this episode Drs. Mikael Petrosyan and Hans Pohl, Chief of Urology discuss what parents need to know about bedwetting. 

Transcript

Intro

Speaker 1 0:09

This is certification surgical education for parents. We are here to inform inspire certification episode seven, bedwetting Dr. Hans Paul chief of urology children's national hospital. Welcome to certification to another episode of our , uh , podcast. My name is Michael [inaudible] and I'm your host today? I have privilege having Dr. Hans Paul. He's a chief of urology at children's national hospital. As you know, this podcast is created for those parents or anybody in the world who wants to learn about pediatric surgery, everything PX surgery, which entails many sub specialties. One of them is urology, which is pretty important. And , uh , talking to Dr. Paul , we decided to do a podcast on bedwetting , which is pretty common and concerning, and a question or issue for many parents. Welcome to certification Dr. Paul, thank you for being here. Thank

Speaker 2 1:11

You. It's a privilege and honor to be here,

Speaker 1 1:13

Michael. Definitely not the last time. Yeah. Well, I have some questions prepared for you. Hopefully we be able to teach many parents and including myself about childhood bedwetting problems.

How Come Are Bedwetting Problems?

Speaker 1 1:25

How common are childhood wedding problems?

Speaker 2 1:29

Uh, well, well, as you know , um, being a parent yourself as every kid basically , uh, grows up in diapers until they're about two years old. And , uh, so every child technically wets the bed , uh, what happens is that , uh, when kids are about , uh , three to four years old , uh, and have , uh, completed their daytime urinary control, they then develop nighttime control also. And so there's actually a fairly , uh , set pattern of how kids develop control of , uh , daytime , uh, poop and urine , um, control. And then , uh , nighttime pooping you're in control. And , uh, the last , uh, function that we learn how to manage is actually a nighttime , uh, control of our urine. And so , uh, it has been estimated that about , uh , 15 to 20% of kids who are about five years old are still wetting the bed. And the number then starts to go down from there with each passing year, there are more and more kids who become dry are all childhood

Speaker 1 2:37

Wedding problems,

Are All Wetting Problems the Same?

Speaker 1 2:39

the same in kids.

Speaker 2 2:41

Well, we , um, in terms of bedwetting , um, we, we discuss it in terms of kids who never became dry. So these are the kids who , uh, managed to become dry in the daytime and have , uh , urinary control in the daytime, but never were able to get out of diapers at night. Um, and that's compared to kids who were perfectly , um, potty trained , if you will, for nighttime control. And then they actually develop bedwetting

Speaker 3 3:08

Two distinct populations, two distinct

Speaker 2 3:11

Populations. And this of course , um, is very different also from daytime urinary control issues. And there are some kids who have , uh , daytime control issues who do not have any nighttime control issues. So they're dry at night, but they wet during the day. And then there are kids who actually have a control issues during the day and during the night. And so , um, we have to untangle all of the symptoms when parents bring their kids in saying my kid wets.

Speaker 3 3:39

So when should a

When Should I See a Urologist?

Speaker 3 3:41

concerned parents address this issue? Is there a certain time, or when do they need to worry about when their child starts bedwetting ?

Speaker 2 3:51

Yeah. Right. So , uh, we generally don't want to see kids until they're about seven years old because there is still kind of a range between five and seven , uh, which , uh, some kids are still wetting the bed and it's relatively normal or

Speaker 3 4:07

Safe to say when your child is five to seven Israel to the okay.

Speaker 2 4:12

Relatively . Okay. It's not alarming. Right? So Sarah was certainly, some of their friends are probably dry at night, but it's still not alarming if your kid is wetting the bed at that age. But then after the age of seven, if they're still wetting the bed, then that's about the earliest that we would want to do anything about it. Um, and it's also dependent upon whether it's a problem for the kid . So a lot of the treatments that we give , uh, recommendations for , uh, rely on the kid, also being interested in becoming dry. So some kids are not particularly bothered by , uh, the wedding at night. And , um , so they become much more difficult to treat.

Speaker 3 4:51

How often do these children with wedding issues also have

Do These Children have Bowel Issues as well?

Speaker 3 4:55

constipation and bowel control problems, right?

Speaker 2 4:58

So, so this has been, this has been really hotly kind of debated as to whether these kids are constipated or not constipated. And , uh, the data are somewhat unclear about that because , uh, we don't really have the best tools to diagnose constipation in kids. Um, as you know, there have been a variety of, of groups , um, uh, out of , uh , Rome that have tried to define what is constipation in kids. Uh, and , uh, people have tried using x-rays and they've tried using ultrasounds. And we really don't know what we do now is that , um, as many as one out of five kids who wet the bed at night , uh, if you treat them for constipation, the bedwetting actually can improve. So it suggests that there is a certain amount of yeah . Relationship between , uh, between that, but not in all kids. So there are other kids who actually have bedwetting for a variety of other problems. So for instance, some of the kids, they may have parents who at the bed. And so you actually stand a reasonable chance of wetting the bed yourself. If one of your parents , uh, wet the bed , um, if both parents wet the bed, then you have about a 70 to 80% chance of becoming a bed wetter yourself. So it really does matter.

Speaker 3 6:15

How do you treat

How Do you Treat Bedwetting?

Speaker 3 6:16

bedwetting problems? Is there a medications you have to give? Is there certain behavioral changes that kids have to do?

Speaker 2 6:24

How we attack it is if you first have to really get the symptoms of wedding symptoms. So the, as I said before, kids either are just wetting the bed and in the daytime, they have normal urine control and normal bowel movements, or are kids with sort of a mixed pattern. So they have daytime symptoms as well as nighttime symptoms. So what we first need to do is we really need to go and get a good history. Um, I tell all of our trainees and all of our pediatric nurses that 90% of understanding , uh, urinary control issues really depend on getting a really good history from the parents. Um, and, and so that really relies on , uh , oftentimes having the parents take a, a survey or a questionnaire home , uh, and maybe even record what the child's symptoms are during two or three weekend days when the parent is able to really observe what the child is doing, kind of, as I like to say in their natural habitat. Um, and , uh, and then with that, you can figure out whether it's a , uh , a daytime plus nighttime problem or nighttime problem only, but for the purposes of making it simple, let's just assume that it's just the common nighttime bed wetter. So there are really only two treatments. One is a bedwetting alarm and the other is medication and the bedwetting alarm works very well. It has the longest , um, success rate. So if you, once the kid gets dry using the bedwetting alarm , uh , they generally stay dry and they don't relapse. And how has the bedwetting alarm works? So it's interesting. Um, we don't exactly know why kids wet the bed. Um, there probably is some, a difference in the way that they send splatter filling. And so when , uh , they have a full bladder, the bladder should wake us up and send us to the bathroom, even if it's in the middle of the night, but these kids don't, they don't wake up and they sleep completely through , uh, the, the event. Um, and so what the alarm does is it senses when the child begins to urinate and it makes a very loud sound and the idea it doesn't stop. Uh, oftentimes they , they may actually continue to, to urinate, but what it does is it's supposed to then wake the brain up, teach the brain to wake up in association with that level of , of sort of stimulation from the bladder. Um, what's also unfortunate is that it's extremely loud , uh, and generally wakes the entire rest of the house up. In fact, in the beginning, it probably wakes everybody else in the house up and except the child. Right. And so that becomes extremely frustrating, particularly for houses where, you know, there are other kids in the house and everybody is waking up and wondering why, you know, Timmy's alarm is waking everybody up and it's loud. Um, I, I, once , uh , I correlated actually the, the loudness of the sound to common sounds in our environment and the decibel level of the bedwetting alarm is the same as a hammer . Yeah .

Speaker 3 9:49

That's pretty loud. It's pretty loud.

Speaker 2 9:52

So , uh , in terms of the medication , uh , you can use the medication. It does work very well in many kids, but it's a way of sort of fooling the body into thinking that , uh , the bladder is empty. You know what I mean? It , it, basically what it does is it slows down urine production at night. And so if the bladder doesn't get full, then there's less opportunity for it to release. And so when you come off the medication , since you haven't trained the body to do what's supposed to happen, then when you come off the medication right, then, then what happens.

Speaker 3 10:21

There is no quick fix. You're saying the best way is the bed alarm. Right?

Speaker 2 10:26

Right . The better, the better way is the bedwetting alarm, which is the non quick fix. The medication can actually be a very quick fix, so we can actually get kids dry , uh, within three to four weeks of starting the medication. So there , there is an advantage, for instance, when kids are wanting to go off to summer camps or, you know, boy Scouts, sleepovers, or just to sleep over to their friend's house of knowing that you have a tool to get the kid reliably dry that night. So it definitely works in those circumstances. Um, but , um, but it's not necessarily a cure. So you have to then be , it's a quick fix, right? So I look at the bedwetting alarm as a cure. I look at the medication as management. I see. So

Speaker 3 11:14

I can

Can these problems be cured completely?

Speaker 3 11:15

bet alarms and medications completely cure the child from bedwetting .

Speaker 2 11:21

Yeah. So both can, so one way to look at the medication as a, as a form of management is that if you, if you acknowledge that every kid eventually becomes dry. Well, almost every kid, because there's about a , up to 3% of the adult population has some bedwetting problems. Uh, but if you acknowledge that , that basically 97% of us become dry at some point during childhood, then you could certainly use the medication as a way to manage the wedding issue until the child is going to naturally outgrow the bedwetting. And at that point you could stop the medics .

Speaker 3 12:01

Okay.

What about Children who Regress?

Speaker 3 12:02

So what about those kids who were doing fine? And they had some sort of psychological stress and now they started , uh , bedwetting . Um, do you, how do you treat those kids or do you just remove this, that psychological stress or any stressors in her life and that a bedwetting problem miraculously goes away? Or is there a tree the same?

Speaker 2 12:25

Uh, yes. Um, if the underlying problem is the psychological stressor, then you have to manage the psychological stress. And so the secondary nocturnal and your recess, or the secondary bed wetting the bed wedding that basically comes later in life is bedwetting . That is a response to something bad that's happened in the child life. So perhaps bullying or a death in a family member or separation divorce , uh , or , um, being part of the foster care system. These are the kinds of things that we typically see. Um, very, very rarely though, there are what we would call organic causes. So a real sort of medical reason for it to happen. And , and so rarely we do pick up some neurological problems , uh, spinal cord issues , uh, in some of the kids that start wetting the bed at night. So , uh, you can't just dismiss it as, Oh, the kid is stressed out and let's give him some time. Um, it does make sense to see a pediatric urologist to make sure that there is no underlying medical reason for the , for the bedwetting . Okay .

Speaker 3 13:37

So

Take Home Message

Speaker 3 13:38

what would be your take home message to parents whose kids have bedwetting issues?

Speaker 2 13:45

So the first thing that I would take, because

Speaker 3 13:48

That's what the parents worry, as , you know, you worry about everything,

Speaker 2 13:51

Right? No, yeah, no. As a parent. Yeah. So as a parent, I know, I know you worry about every single thing, every, you know, pin that drops in the night and the answer. Exactly. Um, the first thing that I would say is that this is a very common problem and , um, and it is not a problem that is really in the child's , um, under the child's power to , uh, to treat okay. Um , no child wants to wet the bed , uh, and , uh, there , depending on the age of the child, there's probably also some embarrassment and shame that surrounds the fact that they are still wetting the bed and they know that their siblings or that their friends are not wetting the bed. So I think that that's the first thing to , to keep in mind. Uh , the second thing to keep in mind is that it is a problem that as I said, is going to go away. Um, luckily we do have methods to help it go away faster than perhaps , uh , it naturally would. And the third I would say is that , um , getting angry and frustrated about it is certainly not going to help , uh, because , um, I'm sure that everybody is frustrated about it and , uh , cooler heads definitely will prevail in the end.

Speaker 1 15:05

Thank you for a Metro being here. I hoping this is not, this won't be the last time that you were invited as a, as a speaker. We appreciate having you here and teaching parents about bedwetting . Um, if you have any questions you can go to children's national.org department of urology, Dr. Poland team can be found. There. There is , uh , he has a large team of urologists working with many neurological issues, and hopefully they will be able to help you if your child has any neurological problems otherwise see you next time when our next episode of certification. Thank you.