By Dr. Jill Ombrello
Bedwetting beyond 2-3 yo (or sometimes known as "nocturnal enuresis" or "incontinence") can feel like a shameful secret or defeating challenge for both the parent and child. Most often, parents are unaware that this is an issue that affects approximately 20% of all elementary school children. And for some, this problem can persist well into teen years and can even be an issue for adults if the root cause is never addressed.
Fortunately, there is a solution beyond dietary habits, bed pads, alarm clocks, diapers, and all of the easily Google-able tricks and tools that most parents employ but can have an effect on a child's self esteem and lifestyle.
Children often feel embarrassed and guilty over wetting the bed, and may even deny themselves the fun of sleepovers or overnight camps because they are afraid that someone might find out, damaging both their social life and their self esteem. Meanwhile, parents grapple with frustration and anxiety when they are unable to help their children.
While bedwetting itself isn’t a serious health concern, it can be a symptom (or outward sign) of a deeper problem for your child which does need to be addressed, a sort of natural alarm-bell that something is going on with your child while they are sleeping.
In a comprehensive review of 98 different research articles done historically, this analysis concluded the following:
Studies have found that children with obstructive sleep apnea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterized by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides....
Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasized. Consequently, symptoms such as snoring, sleep apneas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.
Some children just need a few more years to develop the connection between brain signals and the
bladder, but some children need minimally invasive therapies or procedures to help guide proper development and eliminate bedwetting.
The challenge to getting to a solution for these children is further compounded by the following factors:
Obstructive sleep apnea often goes undiagnosed because it is different than what most adults would recognize in other adults. Children don't have to be snoring to fall under this "sleep apnea umbrella", but merely breathing loudly or audibly is considered abnormal and a sign that they need further testing.
Even if the child is eventually taken for evaluation, the parent takes them to a physician (either pediatrician or urologist). While this is very reasonable of the engaged and motivated parent to do, many physicians are limited in understanding this link between sleep apnea and enuresis, and even if they are educated in the area, they are typically only familiar with the therapeutic options available in the medical field, which includes a CPAP machine, surgical removal of tonsils and adenoids, or chronic use of steroids or other medications to manage symptoms. (As a disclaimer, this is no criticism of physicians, as we understand the extent of ongoing changes and education in their field, but we are alerting you of this issue both because it is just plain true, and also because it oftentimes takes an engaged parent to advocate for their child and find the solution.)
So, it is only if a child just so happens to be treated by a physician who understands the full scope of all advancements related to this specific problem and the partners with whom to treat this issue that a child may get referred to a dentist to receive the proper treatment.
Because what most don't know (but I'm hoping to "spread the word" with this blog ;) ) is that intra-oral appliance therapy is a very easy, non-invasive preliminary step to treating the root cause of this issue.
The good news is, there’s no need for you or your child to suffer any longer! Bedwetting has been shown to be associated with sleep disordered breathing (SDB), a condition caused by easily-correctible, anatomical deficiencies such as a restricted, underdeveloped airway, improper tongue placement, and/or dysfunctional nasal breathing. Essentially, SDB occurs when a child is not getting sufficient oxygen while they are sleeping, and so the neurochemical processes that should occur and improve during proper sleep cannot occur. When the body’s sleep cycles are thrown off in this way, it can result in problems like bedwetting, fatigue, anxiety, poor immunity, increased inflammation, hyperactivity among other issues.
Our Super Health program uses removable, myofunctional dental devices to guide jaw development and open up the airway, allowing children to experience a good night’s sleep — possibly for the first time in their lives -- and to eliminate bedwetting both swiftly and permanently. Many of our patients see results in a matter of days or weeks. There are numerous other benefits to this early interventional therapy to promote proper growth and development for a lifetime of systemic wellness, but we think eliminating bedwetting is a major win to get started.
If your child suffers from bedwetting, there’s no need for them to avoid sleepovers — or for you to do a nightly load of laundry. Call our office at 214-368-0900 or email us at email@example.com to schedule a complimentary consult with our team of specialists today!