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The Answer Doc with Dr. Christopher Munger, M.D.

Bed-wetting symptom of other problems

    Q:  My seven-year-old daughter has just started wetting the bed at night. Last week she had an accident while at school.  She hasn’t wet the bed since she was 4. Is this something I should be really concerned about or is there possibly a simple explanation?

    A: Bed-wetting or enuresis is a common problem that affects many young children.  Approximately 3 percent of girls aged 5-7 and 7 percent of boys aged 5-7 will be affected by this problem. There are two body systems that are most commonly involved in the process that leads to children having problems with bed-wetting.
     1. Problems with the reticular activation system (RAS):  This is the part of the brain that controls how we wake.  It is a complex neurological system that allows us to sense that we need to wake given the urge to urinate.  Children having problems with the RAS don’t sense the urge to void and simply void in their sleep. This type of bed wetting problem responds best to bed-wetting alarms and biofeedback techniques that can be taught to parents.
     2. Problems with bladder spasm: The detrusor muscle is what causes the bladder to contract. When this muscle spasms, it can lead to sudden urges to void and often evacuation of the bladder.  There are a number of causes to bladder spasm. Some are complex.  Some are quite simple and can be easily corrected, which we will discuss in a second. This type of enuresis often responds to medications.
    Getting back to the question, often times when a child suddenly starts having problems with bedwetting or daytime accidents there may be a simple cause.  
    First, your child may have a bladder infection. Although, not common in children, bladder infections can cause severe bladder spasm and can lead to incontinence and enuresis.  You may want to ask your daughter if it burns when she urinates or feels like she has to go all the time. Even if the answer to these questions is no, she should have here urine tested by her doctor. If she does have a bladder infection, treatment may cause the bed-wetting to stop.
    Second, your child may be constipated. In small children, when the colon is full of stool, it can press on the bladder and cause spasm, which can then lead to enuresis. A colleague of mine that is a urologist says the constipation is one of the major causes of bedwetting that could be taken care of by pediatricians and family doctors without need for referral to a specialist. A simple X-ray could show whether or not your child is constipated. Starting a good bowel regimen, including good hydration, lots of fiber and possibly medication could not only relieve your child’s bowels but put a stop to the bed wetting as well.
    The most important fact is that bedwetting and accidents are not “normal” for 7-year-old kids. No longer do kids just need “grow out of it.” Whether the solution is simple or complex, your doctor can offer you many options to combat this medical condition, helping your child’s self-confidence and lightening your laundry loads!

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He recieved his bachelor’s degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.

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