Wets 2 Hours into Sleep

“My 7 year old son wets 2 hours after he goes to sleep. He always goes to the bathroom right before bedtime and doesn’t drink anything after dinner. His bedtime is 8pm and when I check on him when I go to bed at 10:30, he is often already wet. This doesn’t make sense to me since he can easily go more than 3 hours in the daytime. What’s wrong?”

I don’t think there is anything “wrong”. I frequently see this pattern of wetting, especially in children who have just begun using a bedwetting alarm. Since parents now know when the wetting is occurring, they are surprised and amazed that it occurs so early in the sleep cycle. In children with bedwetting, it seems that their bladder and pelvic floor muscles relax and let the urine flow out when their body relaxes and falls into deep sleep. Their bladder isn’t so full that it can’t hold any more urine; their body just lets the accumulated urine out at the wrong time. Two hours into the sleep cycle is when we are all very groggy, can’t make sense of where we are, and have very little memory of this sleep interruption. Parents observe a disoriented child, who may be combative or resistant, who do not remember the alarm at all in the morning.

When your son is ready to stop bedwetting, he will make great progress with a bedwetting alarm. Initially, the alarm will sound early in the sleep cycle, when he wets. Help him turn off the alarm and get up to the bathroom. He may not cooperate at all in the beginning (that will come later). Reattach the alarm because he may wet a second time later that night. Over the first few weeks, you will begin to see his pattern of wetting change. Instead of wetting in two hours, the wetting will happen later. His body will begin to learn that letting the urine flow out when in the deep sleep phase isn’t the best time to respond. He’ll begin to “hold it” longer and will respond more appropriately when the alarm sounds four to six hours into his sleep cycle. Eventually, he’ll get up before he wets or hold it until morning.

Continue to have him urinate twice before bed, about 30 minutes apart and limit evening fluids to water. Drinking a lot throughout the day will prevent him from being thirsty in the evening. Stopping disposable pants once he begins using a bedwetting alarm is a good time to transition to regular underwear in the nighttime. Using a waterproof mattress overlay on top of his sheet helps with clean-up.

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NEW Custom Clippo Alarm

Rodger Clippo alarmThis fun new Clippo Wearable Bedwetting Alarm has just been added to our selection. This alarm has 8 sounds and a strong vibration, a magnetic shoulder clip and a clip-on sensor for the underwear. The sensor attaches securely to your child’s own underwear and quickly senses the first drop of wetness.

But the best part about this alarm is that your child can choose the skin for a customized look. Most parents know that children are more excited about something that “looks good” and appeals to their interest. Putting the alarm on each night before bed is fun when you can use something that looks like a soccer ball, basketball, or pink flowers. You can choose one free skin when you buy the alarm and shop for additional ones anytime.

This economically priced alarm is well suited for a child who likes to play a role in choosing their own toys, clothes, school supplies, etc. Having a say in what style of alarm skin to get may make a huge difference in the level of cooperation, and ultimately, their level of success. The Clippo Starter Kit includes 2 mattress overlays and the book “Seven Steps to Nighttime Dryness” to help guide you on the journey to dryness.

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Constipation and Bedwetting

Constipation may cause or contribute to bedwetting in some children, according to the results of a new, small study published last month in Urology. Thirty children with bedwetting, aged 5 to 15, who sought treatment for bedwetting had an abdominal x-ray to evaluate the amount of stool in their rectums. The researchers found that all 30 had excess stool in their rectums, despite reporting normal bowel habits. After laxative therapy, 25 (83%) of the children were cured of bedwetting within 3 months. http://www.medicalnewstoday.com/articles/241113.php

As a follow-up to this study, I would like to see a larger sample size, a double-blind study (in which children received a laxative or inactive therapy), data 6-12 months later to evaluate relapse, and the timing of the abdominal x-ray to be after the children had a spontaneous bowel movement.

This small study does bring up the importance of looking at bowel and bladder habits when treating bedwetting. Having an abdominal x-ray to evaluate stool in the last 4-5 inches of the rectum would seem important, especially in kids who are not responding to conventional bedwetting treatment or prior to starting medication. This kind of constipation occurs when children put off having a bowel movement. The stool is backed up and the bowel is never completely emptied.

Here are some tips to manage constipation:

Insure adequate fiber intake. A guideline for fiber requirements in children is their age plus 6. For example, a 8 year old would require at least 14 grams of fiber a day. My patients’ favorite source of fiber is Cracklin’ Oatbran Cereal. Read labels when buying food and opt for the higher fiber choice. Fiber bars or drinks can also be used.

Add products such as Miralax, with your health care provider’s guidance, if fiber isn’t adequate. Miralax is unflavored and is dissolved in the drink of your choice. It is a gentle way of softening stools and the dosage can be easily adjusted.

Have a regular stooling time, where she sits quietly and has uninterrupted time in the bathroom.

Provide a stool for her to put her feet on and a toilet lid insert if she feels like she will “fall in”.

Stop to have the bowel movement when he first gets the message. Holding it in until he gets home can create a vicious cycle.

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