You may have friends or know somebody with a child who has wet the bed since they were a baby. This is known as Primary Nocturnal Enuresis and is often caused by a chronic health problem or developmental disability. Factors such as psychological problems do not cause Primary Nocturnal Enuresis, whereas they can often be a cause of Secondary Nocturnal Enuresis. SNE is a condition that develops at least six months after they have learnt to control his or her bladder. As a parent, this can be shocking and alarming, so it is important that you are aware of what to do when this occurs.
Is your child experiencing daytime wetting? Read our blog about looking after your incontinent child.
Should I Be Worrying?
If your child was previously dry overnight but has experienced regression (SNE), you should talk to a professional. It is also important to consider the age of your child if they are experiencing leaks. According to the National Association for Continence, most children should have achieved urinary control and are dry both day and night by the age of 5. If your child is 6 years old and is still not dry overnight, you are advised to consult a Doctor.
Why is My Child Wetting the Bed Again?
Underlying medical conditions account for a large fraction of children with Secondary Nocturnal Enuresis. It has been found that 15-20% of children with a bladder infection suffer from Secondary Nocturnal Enuresis. Children with Diabetes are also at high risk of developing incontinence, as it can cause excessive amounts of urine as well as heightened thirst.
You should not ignore factors such as family life and important events when considering reasons for bedwetting. Psychological stress is also known to be associated with wetting the bed after gaining continence. Research has shown several important comorbidities between a child’s neuropsychological dysfunctions and wetting the bed. It is thought by experts that the coexistence of these problems can be attributed to a common central nervous system involvement. Psychological factors are far more common with Secondary Nocturnal Enuresis than Primary Enuresis. This link is considered to be a regressive symptom in response to stress or trauma. Sexual abuse can be a factor in children with bedwetting issues who were previously dry during the night.
Hormonal problems in children is a common, invisible cause of Secondary Nocturnal Enuresis in children. The hormone called vasopressin tells the kidneys to produce less urine at night. Some children are not producing enough of this hormone, which causes wetting at night.
Constipation is another popular factor that can cause loss of bladder control at night. Surprisingly, if a child has a lot of stool in his or her rectum, it may push against the bladder. This can confuse the nerve signals, causing the bladder to believe it is fuller than it actually is. A full rectum can reduce how much urine the bladder can hold and how well the bladder empties. This is a problem that is worth looking at, as many people can be surprised at how effective treating constipation can be.
Other factors that contribute to nighttime incontinence include a small bladder capacity and structural problems. If you are worried your child may be having problems due to these factors, ensure you take them to a Doctor.
What Do I Do Now?
Research shows that the emotional impact of Secondary Nocturnal Enuresis can be significant. The family and child can feel embarrassed and experience reduced quality of life. It is therefore vital to avoid making your child feel guilty or losing your temper and focus on finding a solution. Some medical conditions are easy fixes and the leaking will disappear with a course of antibiotics. However, if your child has Secondary Nocturnal Enuresis, it is important to take them to have a physical examination with a paediatrician. It is invaluable to consult with your child’s GP for guidance on how to treat Secondary Nocturnal Enuresis. A Doctor will carry out a simple urine test, where urine is examined for signs of a disease such as Diabetes.
Behavioural methods and motivational therapy are often tried initially, with similar treatment options attempted to Primary Nocturnal Enuresis. Paediatrician Naiwen D Tu asserts, “most children with Secondary Enuresis have no identifiable cause and are treated in the same manner as children with Primary Enuresis”. Initially, motivational therapies are tried for treatment. A study in 2016 showed that motivation therapy works as a first-step treatment for children with Nocturnal Enuresis. This is recommended for children who are within the age group between six and eight and do not have an intense amount of bed-wetting at night. This method of therapy uses praise, encouragement and rewards to help a child gain bladder control. Larger rewards are provided for longer compliance with good behaviour. This method is estimated to be successful in 25 percent of children and leads to significant improvement in more than 70 percent of children. It is important, however, never to punish a child for leaking or make them feel bad about leaking. Another important lifestyle step is to assess your child’s diet to ensure the bedwetting is not temporary or triggered by bladder irritants. You can eliminate food and drink containing a lot of caffeine or sugar in the evening. You should also ensure your child does not drink a lot of citrus juices and liquids artificial flavourings.
Interventions such as purchasing enuresis alarms are often tried as the child gets older. Designed to ring or buzz to wake your child the moment bed-wetting starts, alarms can help children form a habit and train their bladder. You can purchase an alarm, or in some cases, they are supplied by your healthcare service. You should assess the response to an alarm by 4 weeks and continue with treatment if the child is showing early signs of response. The ERIC advises, “discuss with your child what you expect them to do when the alarm goes off, e.g. get out of bed, go to the bathroom, change their pyjamas and strip off the bottom sheet”. You can continue alarm treatment in children with Secondary Nocturnal Enuresis until 2 weeks of uninterrupted dry nights has been achieved.
Whilst behavioural and natural treatment is recommended, some children will require medication. If your child is lacking the vasopressin hormone, an artificial form, called Desmopressin can be prescribed. This can be taken just before bedtime, either for long-term or for nights away. Taking this medication is recommended when a child is staying overnight at a social event or setting to avoid embarrassing leaks.
You can shop our range of children’s incontinence products to be proactive and prevent accidents.
Are you an adult experiencing Nocturnal Enuresis? Have a read of our full guide to Nocturnal Enuresis.