Bedwetting & Elimination Problems

Hi, everyone. I've read through several posts here and am grateful to find that I'm not alone with the bed wetting problem.

My DD, who'll be 6 in October, still wets the bed almost every night. I'd like to get her tested to see if there's an underlying cause of her bed wetting, especially since DH and MIL are both harping on DD about her problem. They both think that DD is doing the bed wetting on purpose (DH thinks she's just too lazy to get up) and that she can control her bladder if she really wanted to. MIL has gone as far to call DD "a bad girl" for wetting the bed. (I swear, I'm more frustrated at DH's and MIL's behavior than at DD's bed wetting.)

What test(s) should I get done first? Should her bladder hormone levels be checked?

I did some more research and found this from the Dr. Sears website (here's the link to the entire page <https://www.askdrsears.com/html/7/T071200.asp>):

"Step 2: Do a medical evaluation
Your doctor will want to know the results of your diary, the correlation you have noticed and the changes you have made. Your doctor will do a complete physical examination to detect if there are any neurological problems that may affect the urinary tract, such as spinal cord abnormalities that may affect nerve supply to the bladder. Abnormalities in the external genitalia, such as a misplaced urethral opening, may give a clue to deformities inside. Your doctor may watch your child urinate and examine the force of the flow. A "stuttering stream" rather than a smooth flow may be a clue that there is a structural abnormality in the child's plumbing. A urinalysis and urine culture may be performed as a screening test for kidney function and to exclude a urinary tract infection. To gauge your child's bladder capacity, the doctor may also ask you to measure your child's volume each time he urinates over a three day period to see if he has a functionally small bladder. The usual bladder capacity is a child's age plus two ounces. So, a six-year-old should be able to hold eight ounces of urine.

Finally, if an abnormality of the urinary tract is suspected, your doctor may refer you to a urologist to perform studies such as an ultrasound VCUG (an x-ray picture of how the kidneys and bladder function) to reveal possible abnormalities that could prevent your child from keeping dry all night. The good news is that over ninety-five percent of children have no urinary tract abnormalities causing the bedwetting.

Once you've excluded a medical problem, you're ready to begin a night- training program. In order to achieve success, your child must cooperate with the program and take responsibility for his nighttime dryness. Consider this a team approach: the doctor, the parents, and the child. After all, your child has to learn to control his bladder. You can't control it for him you can only help. In fact, your job is to understand bedwetting, work out a night-training program, be consistent with it, and the rest is up to the child."

To overcome bedwetting, two things need to occur (generally speaking). First, the child must develop the hormone that signals the kidneys to slow urine production. Without that hormone, the child produces too much urine to stay dry. Second, the child needs to learn to awaken to the sensations of a full bladder.

If your dd has always produced a lot of urine overnight, then she's probably not yet developed the hormone necessary to stay dry at night. If your dd wets less than she used to and/or has occasional dry nights, then she's probably ready to start training her body to awaken to a full bladder by limiting fluids before bed and taking her to the toilet once during the night.

FYI, most doctors don't consider bedwetting much of an issue until a child is 7-8yo. Even then there's not a lot the doctors can do except perform an exam to make sure there's no physical cause for the problem (infections, constipation, etc). Some children just take longer to develop the hormone to slow urine production at night.

There is a synthetic version of the hormone available as a prescription drug that some doctors will prescribe for children. It used to be available as a nasal spray, but the FDA discontinued their authorization of it for bedwetting purposes since several children were having problems with it (seizures? I can't remember). The meds are still available in pill form. The meds are just a bandaid until the body develops the hormone on its own. Some people just use meds for sleepovers (assuming they've determined that the meds help).

The American Academy of Pediatrics has a great book called "Waking Up Dry: A Guide to Help Children Overcome Bedwettting," by Howard J. Bennett, MD, FAAP. You can see if your local library has it.

It explains on both a kid level and an adult level various reasons why bedwetting occurs and methods for overcoming it. It gives info about how many children are still bedwetters, how to deal with sleepovers, what medications are available, etc. It's geared not only toward solving the problem, but making the child part of the solution and helping the child not feel badly about being a bedwetter. It even has jokes throughout it.