Austin American-Statesman: Dr. Leslie McQuiston on Bedwetting

Leslie T McQuiston, MD

The Austin American-Statesman interviewed Dr. Leslie McQuiston on causes and treatment for children’s bedwetting.

Bedwetting is a Brain/Bladder Disconnect by Nicole Villapando, Austin American-Statesman.

In summer, kids often are sleeping away from home at hotels and summer camps, places where wetting the bed can be even more nerve-racking.

We asked pediatric urologist Leslie McQuiston with Children’s Urology and children’s psychiatrist and pediatrician Caron Farrell with the Seton Mind Institute how parents can help children who wet the bed.

Leslie T. McQuiston, M.D.
Leslie T. McQuiston, M.D.

First things first. Bedwetting is not considered abnormal until after age 12. About 10 percent of 6-year-olds wet the bed. That number goes down to about 5 percent at age 10 and by adulthood it’s 1 percent. Bedwetting is highly hereditary, but just because a parent stopped wetting the bed at age 8 doesn’t mean a child will stop at the same age. It’s also more common in boys.

You’re considered a bedwetter, or a person with nocturnal enuresis, in fancy terms, if you wet the bed more than twice a week for three months.

Most of McQuiston’s patients are coming to see her starting around age 5 or as soon as it bothers them.

See your pediatrician first to rule out constipation, diabetes, an infection, seizures, a sleep disorder or a psychiatric problem.

Bedwetting is about the brain and the bladder not connecting. It’s considered primary bedwetting if a child has never been dry at night and secondary if a child was dry at night and is now wetting the bed. Often in secondary bedwetting, something is emotionally triggering it, Farrell says. She’ll get more calls around STAAR testing, for example.

Farrell adds that bedwetting “is one of the most common regressive behaviors.”

Parents shouldn’t punish children for wetting the bed because often that will make it worse. Instead, they should deal with it matter of factly.

Both McQuiston and Farrell will go through behavior modifications first.

They look at how much sleep the child is getting (10-14 hours a night is recommended).

They work on fluid shifting. Instead of a child getting fluids throughout the day, they make sure a child is drinking fluids in the morning and afternoon and then stopping about four hours before bedtime. They also look at what fluids he or she is drinking. Chocolate, caffeine, citrus and carbonation can all aggravate the bladder.

They look at how often a child is going to the bathroom during the day. Every two hours is recommended so the bladder is not having to hold onto fluid during the day causing it to not be able to hold fluid at night. They will write notes to schools to ensure kids can go to the bathroom frequently and drink water often.

They ask parents to make sure a child goes to the bathroom before bed and then wake a child up to go to the bathroom before they themselves go to bed.

They also work on positive thoughts because it’s a brain-bladder connection problem. “It’s important to think positively,” says McQuiston. “‘I will wake up dry in the morning,’ instead of negative self-talk, really helps out a lot.” That’s why sometimes kids will not have an accident for a really important event, like a sleepover. They’ve worried about it and planned ahead in their minds. “The brain takes care of the rest.”

McQuiston says acupuncture and hypnosis also have been successful.

If those methods don’t work, they’ll try putting a sensor in the underwear or a pad on the bed to ring an alarm when it gets wet. Farrell says that works about 70 percent of the time because it trains the body to have that connection between the brain and the bladder.

Medications also can be used. DDAVP decreases the amount of fluid made overnight and works on the night you use it, which makes it great for big events like camp or sleepovers. The other main type of drug, Ditropan, helps to relax the bladder so it can hold more and not squeeze out fluid irresponsibly. That has to be taken nightly to work.

Bedwetting is not a time to panic, though. “If a child is not bothered by it and they are under 12, then you don’t have to say anything,” McQuiston says. “It’s a normal part of development.”

Parents should tell children: “This is normal, but there are some things we can do to help manage things while your body is outgrowing the issue.”