ADHD does not cause enuresis (bedwetting) and it is not listed as a symptom of ADHD. However, there seems to be a higher incidence rate in children with ADHD of bedwetting. According to an article published in the Southern Medical Journal in 1997, children with ADHD had a 2.7 times higher incidence of enuresis and a 4.5 times higher incidence of daytime enuresis.
Enuresis can be devastating to children. It may interfere with sleep-overs and cause them to feel left out. Their self-esteem may suffer. For most children, bedwetting ends before the age of five, although somewhere between 5 percent and 20 percent of children still have incidences of bedwetting at this age. Boys have a higher rate of bedwetting than girls.
For most children, the exact cause of enuresis is never known, however, there are some general ideas of why this occurs:
- Enuresis is sometimes hereditary
- There may be a delayed maturation of the neurological system
- Small bladders or increased production of urine during the night
- Urinary tract infections
- Sleep disorders: children may have a hard time rousing once in a deep sleep or may not feel that their bladder is full once in a deep sleep
- Emotional trauma or high stress situations
- Physical problems that may cause enuresis include diabetes or congenital deformities of the urinary tract
Normally, as the child grows older, bedwetting decreases but for some children it can continue into the teen years. It is reported that one percent of teens will still have problems with bedwetting. For these teens, enuresis causes embarrassment and humiliation.
Parents may try a variety of methods to control bedwetting. They may wake their child every few hours during the night to take them to the bathroom; only to have them wet the bed in between bathroom trips. This causes the entire family to go without a proper nights sleep. Lack of sleep can cause distraction and inability to focus to become even more pronounced. Other parents may try punishment or make the child feel ashamed of their behavior. Although done with good intentions, bringing attention to this problem can cause undue embarrassment and emotional turmoil.
Doctors most often will tell parents to wait and see. Most children will grow out of this and simply waiting will clear up the situation in many households. For others, however, treatment is required. Treatment for enuresis may include:
Behavior Modification - This can be parents simply praising a child that stays dry through the night or can include monitoring devices that are meant to wake a child up as soon as there is moisture, building a child's ability to wake up when their bladder is full. Additional suggestions include limiting how much a child has to drink for 2-3 hours before bedtime.
Counseling or Psychotherapy - This method is used more often to help a child through their anxiety or feelings of worthlessness because of the bedwetting. If bedwetting is occurring because of stress either with a family situation, social situation or in school, counseling can help the child deal with the cause of the frustration and in turn may eliminate or decrease bedwetting.
Medication - There are two medications most often prescribed for bedwetting. DDAVP (desmopressin acetate) is considered to be a safe and effective treatment for patients with nighttime enuresis. Tofranil is also used. This medication is also used to treat depression, ADHD and narcolepsy. For some children, medication may be used only when circumstances require it, such as sleep-overs or overnight camp. Other children will take the medication every night for a certain period of time. When considering medication, it is important to discuss with your physician any other medications your child may be on and determine if there may be interactions between the medications.
Whatever method parents may choose, it is important to remember that your children need to feel loved and accepted. Let them know that bedwetting does not stop you from loving them. Let them know that they are still worthy of being loved and that you want to help them because of the problems this may cause for them, not because you are ashamed of them.
AD/HD and Enuresis (Bedwetting), Carol Watkins, MD, Northern County Psychiatric Associates
Clinical correlates of enuresis in ADHD and non-ADHD children, 1995, Biederman et al, Pub Med