Medication

As I’ve mentioned, standard bedwetting medications have not been effective for me. My wetting has a cause that the medications don’t address.

My doctor had a thought about a drug that treats a related problem. It doesn’t typically have adverse side effects, other than that it can make one drowsy if combined with more alcohol than a couple of glasses of wine. I don’t drink much, so that shouldn’t be a problem. So I’m trying it on a low dose.

So far, no change. But she says it may take a week or two.

Tonsils and Bedwetting

Interesting study indicating that about half of the bedwetters (ages 5 to 18) with breathing difficulties while asleep (apnea or snoring) stop wetting the bed after a tonsilectomy. Those who stopped wetting “had significantly more arousals and obstructive apnea episodes but fewer awakenings than” those who continued to wet.

Confirming again a connection between sleep patterns and bedwetting.

Parental anxiety

An interesting paper reporting on a survey of doctors and parents:

“Although both [parents and doctors] thought that bed-wetting is a maturational problem, the parent group thought emotional causes were important and were less likely to accept small bladder size as an etiology.”

Medical research in the last generation has found genetic, hormonal and physiological causes for bedwetting. That would explain why doctors focus on those factors. Parents who don’t know about those studies probably still accept an earlier generation’s belief that bedwetting has emotional or behavioral causes. Or maybe it’s parents’ natural human tendency to believe that their children can control things to a greater degree than their children actually can; that a child could stop wetting if he tried hard enough.

An even more interesting result:

“Parents thought that children should be dry at a much younger age than did the physicians (2.75 vs 5.13 years, respectively)”

Wow. “Should be dry” before age 3.

Perhaps the parents interpret, “children should be dry”, as, “when would I like my kids to be dry”. Three might be a defensible answer to that. Most parents would like their kids to be dry by 3. I would have overjoyed, although given their genes, I didn’t expect it. (I’m sure Mom would really have loved for all her kids to have been dry at 3!)

On the other hand, that’s a high expectation. Surveys say that most kids still wet the bed at 3. I’m generally skeptical about the accuracy of these sorts of estimates, but these surveys seem well constructed.

Part of it may be that parents don’t remember when they stopped wetting the bed themselves. Most – almost all – of us stopped wetting the bed when we were too young to form a memory of it. An excessively rosy belief in one’s toddling maturity probably colors it back a year or two. I don’t remember when I stopped (although I certainly remember when I started again!), and I would be skeptical of anyone’s memory of being dry before 3. The only memories I would trust would be of people who wet the bed until well into school age, and even they would probably tend to nudge that memory.

The doctors may interpret the survey question as, “At what age can one expect most children to be dry?” Plausible surveys indicate that is about 5.

The right question is, “when should I become concerned”. Current medical wisdom seems to be age 7 or 8, unless the child starts wetting again after being dry (secondary enuresis), or bedwetting is affecting the child’s emotional state, or the child has other symptoms of diabetes, urinary tract infection or other medical problems.

Beyond age 7 or 8, one should test and keep an eye out for more serious causes. But the best approach to bedwetting itself is to keep calm, manage the consequences and wait to outgrow it.

Genetics

Something that came as a surprise to me (although it’s relatively old news): Geneticists claim to have identified the locus of genes that correlate with primary enuresis.

I knew that surveys (dating back to the 1970s) suggest that a child is very likely to wet the bed (about 75% probability) if both parents did. If one parent wet the bed, chances are about even that the child will. If neither parent wet the bed, a child generally will not; a child with no bedwetting in the family tree (parents, grandparents, uncles and aunts) is rarely a bedwetter. Those probabilities are for primary enuresis, that is, for a child over the age of 6 who has never been dry. Secondary enuresis (such as mine), which starts after being dry for some time, is not genetically correlated.

The interesting thing — to me, at any rate — is that geneticists have identified the locus of several genes that appear to be correlated between parents who were bedwetters and their children who wet the bed. Some genes appear to be dominant, some to be recessive.

Some of the genes appear to be sex-linked. That would explain why, as children get older, boys are more likely to still wet the bed than girls are. That’s reversed in my family: My sisters wet the bed to a much later age — 16 or 17 — than my brothers did, and my son was dry while his older sister was still wetting most nights.

A few caveats:

My degrees are in mathematical disciplines. I have a low regard for the rigor of medical studies based on surveys. I doubt that the surveys allow the reported precision of the correlations. I doubt that the samples are large enough or representative enough for the correlations to be very convincing. Still, if one allows a wide margin of error, even at an anecdotal level there is a basis for belief.

While I have a background in statistical methods, I’m no geneticist. My knowledge of biology is limited to 9th-grade public-school frog-chopping (for which I got the worst grade of my academic career) and (like most people with math degrees) I regarded biology as only slightly more respectable than alchemy. On the other hand, geneticists do appear to take science seriously and a pointer to an actual gene is interesting.

Treatments

I haven’t had any luck with medication for bedwetting.

Immature anatomy isn’t the reason I wet the bed. My anatomy matured enough that I stopped wetting the bed when I was very little. Consequently, drugs that overcome late development (low hormones, small bladder, …) have no effect (or even a negative effect) on my bedwetting. Given the side effects (some of which are quite nasty) and the fact that I have to wear protection anyway, I have given up on trying to control my bedwetting with drugs.

However, there are drugs — DDAVP, Ditropan, Levsin or Tofranil — that are effective to treat many common causes. Some have nasty side effects, and their effect on bedwetting tends to diminish with extended use. But they can help control bedwetting, particularly for short periods. They can significantly cut the risk of a wet bed (or sleeping bag) on a sleepover or for a few days away from home.

Mother-in-law

We were at J’s parents’, with his brother and sisters and their families, for Thanksgiving weekend.

While we were there, my mother-in-law dressed down Ellen1, my sister-in-law, for “keeping her kids in diapers”. Mother-in-Law saw my niece, Sara, Ellen’s 12-year-old, disposing of a wet pullup.

Sara’s problem, according to Mother-in-Law, is lack of discipline. Wearing a diaper (Mother-in-Law’s word) gives Sara no incentive to grow up and stop wetting the bed. She has no signal to wake up.  She is comfortable in a false security; it is as bad as letting her have an infant’s security blanket. She is lazy. She is looking for attention. She is emotionally immature, and will not mature. The diaper, and not suffering the consequences of wetting the bed, infantilizes her. If she had to sleep in a wet bed, she would stop wetting.

This is part of a larger picture, one convenient opportunity for sniping in an ongoing war. Mother-in-Law thinks her children and their spouses are poor parents. I’m the best of a bad lot; her own daughters and her other daughter-in-law are even worse than I am. I don’t think she really likes any of her grandchildren, although they are all terrific kids.

I am a more conservative, traditional parent than anyone I know. But I am too permissive for Mother-in-Law.

She is an intelligent woman. She has an advanced degree in nursing from a prestigious medical center, although she retired when her oldest was born (40+ years ago).

Without getting Freudian, I wonder if this is driven by something in her own experience. She had a tough childhood, as the only (and unwanted) child of a parents who were narrow-minded and demanding to the point of being abusive. I wonder if she wet the bed and was punished for it or forced to sleep in the wet bed.

Her attitude may have been shaped not only by her childhood, but also by the era in which she learned nursing. As I understand it from my Mom — and from the doctor who would not do anything for me when I was in college — that was the received wisdom at the time, frosted with a dollop of Freudian psychobabble.

Ellen gave as well as she got, which just confirmed Mother-in-Law’s belief that Ellen is a bad parent and insufficiently respectful of Mother-in-Law’s age and wisdom. I didn’t jump in because I didn’t need to. Ellen defended herself (and her kids), along many of the same lines as I have argued here.

Ellen’s kids are a little older than mine. They are seeing the light at the end of the bedwetting tunnel, but they still struggle with it. When they are away from home they wear pullups to protect their hosts’ beds.

I don’t know if Mother-in-Law knew that my kids were in pullups, too. I don’t know about my other nieces and nephews. They are all older than Ellen’s kids, so I assume they are probably beyond this.

If I had told her that I wet the bed — and wear a diaper, too — she probably would have had a stroke.

Nobody wants to be in a wet bed. Trust me: I’ve been there. I’m still there. You only need to have suffered through it once. It is miserable. It is humiliating.

Bedwetting is a symptom. For younger kids, it’s a symptom of slow-maturing physiology: a small bladder, inadequate hormone, deep sleep. The cure is time. The child will outgrow it. For a teenager or adult, it’s generally something more serious.

The idea that it’s laziness, or emotional immaturity, or attention-getting, isn’t just bunk. It’s harmful bunk. It’s bad enough to have a humiliating, demeaning problem. Far worse to be told it’s your fault, that you’re lazy, that you have a mental or emotional problem.

It also leads people to believe that it can be cured with the right incentives. But incentives only work to influence choices, and this isn’t a choice. Punishment, or forcing a child to sleep in a wet bed, might prevent a wet night or two as a child is in the last stage of outgrowing bedwetting. But it’s not going to make a bladder grow or glands produce hormones.

It will certainly cause misery beyond the considerable misery of simply being a bedwetter, of waking up in a wet bed and of having to wear a diaper. And it will cause real harm if it inhibits a parent (or a doctor, like the one at my college) from seeking the real urological, neurological or other medical cause.

Sara — a smart, mature and usually happy girl — was devastated by her grandmother’s attitude and beliefs about bedwetting and about her. My Emily, who heard some of it, and still wets the bed sometimes (and wears a pullup) at age 9, was bewildered. It took a long talk and some tears before Emily was reconciled with herself and her grandmother. I came this >< close to telling both Emily and Sara that I wet the bed, although I wasn’t sure whether that would help or hurt.

1 Names changed to protect the innocent.

College: Doctors

I went to student health services when I started wetting the bed again in college.

The SHS doctor was completely useless and unprofessional. He didn’t bother to examine me. He didn’t bother to take a proper history, even though I told him that I had been a chronic bedwetter as a teenager, and had been extensively tested and examined by urologists, neurologists and endocrinologists. I even used the mystical phrase, “secondary enuresis”.

He didn’t ask me the obvious questions that my family doctor had asked and he didn’t ask about the tests that I had as a teenager. Nor did he order any tests for diabetes or other potential causes.

He told me that college bedwetting was psychological and that I should see a shrink. I told him that I didn’t need a shrink — I was happy with my life, getting straight A’s, and ahead on all my classes. I had lots of friends and an active and satisfying social and love life. I wasn’t stressed or anxious about anything.

He didn’t pay any attention. He wrote me a prescription for one of the drugs that had been ineffective for me as a teenager. He also wrote me an authorization for sessions with a psychiatrist.

I left the exam room and tore up the prescription and the psychiatrist authorization.

One of the nurses saw how upset I was. She took me into an exam room. When I told her what was upsetting me, she laughed — She had assumed that I had just been told I was pregnant.

She told me that I was not the only student who wet the bed. If I had noted it on my freshman questionnaire, the college would have offered me my own room or a bedwetting roommate. She could arrange a change in my rooming and could provide me with briefs (she didn’t use the d-word).

I didn’t want to change my rooming. I told the nurse that it wasn’t going to be a problem. I had practice discreetly changing during my first semester and when I had to deal with an occasional wet bed. But I would definitely take the briefs.

The nurse also arranged for me to see a urologist, who was everything the SHS doctor was not. We had a long conversation, and he consulted with my family doctor and the specialists I had seen as a teenager. He did the urological tests on me, but I did not want to endure all the testing that I had as a teenager.