Nocturnal / Secondary Enuresis

KNOWLEDGE IS THE FIRST STEP ON THE PATH TO DRY NIGHTS

Nocturnal enuresis, also referred to as primary nocturnal enuresis, is the medical term for bedwetting.

Nocturnal enuresis applies specifically to children who have always wet the bed, as opposed to the other forms of bedwetting, including secondary enuresis (which is when a child has been dry for a consecutive period of six months and then starts wetting the bed again).

Bedwetting is an extremely common. In fact, up to 15% of five year olds and up to 5% of ten year olds wet the bed. Around 97% of children have grown out of bedwetting by the age of 12, so most cases are nothing to worry about and simply require some love and support.

The cause of bedwetting for a child who has always wet the bed is usually fairly common bladder development delays, amongst other causes, which generally iron themselves out over time.

What are Primary and Secondary Nocturnal Enuresis?

Bedwetting refers to uncontrolled urination – children who wet the bed do it neither consciously nor deliberately. Primary bedwetting occurs when young children lack bladder control from infancy. Persistent bedwetting, that is bedwetting that occurs at least once or twice a week, is typically not considered to be a problem until your child reaches school-age. Secondary nocturnal enuresis (SNE), on the other hand, occurs when a child or adolescent has maintained proper control over their bladder during the night for at least six months or more then begins to wet the bed again. Secondary bedwetting accounts for approximately 1 in 4 of all bedwetting cases, with the number of children with secondary bedwetting increasing with age. Secondary bedwetting often catches children and families by surprise and can be particularly distressing for all involved. Children who are more vulnerable to this are ones who took longer to achieve nighttime continence.

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WHAT CAUSES NOCTURNAL ENURESIS?

Nocturnal enuresis has various causes; not all children will wet the bed for the same reasons.
These are the most common causes of nocturnal enuresis:

Neurological development delay: If your child’s nervous system is still developing, the bladder may not be able to signal the brain to wake up for a bathroom visit.
Genetics: If both parents wet the bed as children, there is a 75% chance that their child will also experience bedwetting. The chances decrease to 40% if it’s just one parent, and 15% if neither you nor your partner were affected.
Under-production of anti-diuretic hormone (ADH): ADH is a hormone that regulates urine production while we sleep. Some children do not produce enough of this handy hormone, which causes their bladders to become full during the night.
Small bladder capacity: Sometimes a delay in bladder development can result in low capacity and cause the need to urinate during the night.

HOW TO MANAGE NOCTURNAL ENURESIS

Bedwetting can be a source of emotional distress to child sufferers and is often damaging to self-esteem. Providing lots of love and emotional support during this time is necessary and will help reassure your child.

Explain to your child that this is just a very common phase they’ll eventually grow out of.
If they’re old enough to use the internet, help them research bedwetting causes and management techniques – being informed can help them feel more in control of the situation
Never punish your child for wetting the bed, as this can lead to feelings of shame, anxiety, and confusion.

WHAT CAUSES SECONDARY ENURESIS?

Causes of secondary enuresis vary and tend to fall into one of two categories; emotional and physiological. In most cases the trigger will not be a medical issue.

Urinary tract infection (UTI): UTIs can cause frequent urination and/or the need to urinate urgently in the sufferer. A simple urine test will help identify an infection, which can usually be treated easily with antibiotics.
Diabetes: Frequent urination is a symptom of type 1 diabetes. Your doctor will be able to run tests in order to figure out if this is the problem.
Neurological abnormalities: Even a slight imbalance in the nervous system can cause secondary enuresis.
Constipation: Blockages in the rectum can put pressure on the bladder and reduce its capacity to store urine overnight.
Obstructive Sleep Apnea: OSA can result in increased nighttime urine production, which can lead to a return to bedwetting.
Emotional stress: Big changes in a child’s life can cause emotional stress, which is a common trigger for bedwetting.

WHAT TO DO IF YOUR CHILD IS SUFFERING FROM SECONDARY ENURESIS

There are a number of things you can do if your child has started wetting the bed again.

Talk to your child, and try to think of anything that changed around the time the bedwetting started again, as a team. Write down all possibilities to discuss with your child and their GP.
Note whether your child is displaying any other sign of stress, such as irritability, headaches, outbursts or tantrums which are out of character, crying, or social withdrawal.
If you suspect a medical condition, you should visit a doctor as soon as possible and have your child undergo the required tests. It’s usually a good idea to rule out a medical problem anyway, even if you strongly suspect it’s a psychological cause.

SECONDARY ENURESIS TREATMENT

Treatment for secondary enuresis will depend on the cause. Some medical conditions, such as UTIs are easy fixes and will usually disappear with a course of antibiotics, while others may be more serious.

Bedwetting caused by emotional stress can sometimes be a little trickier to deal with and your child may need to speak to a counsellor. Less traumatic stress triggers, such as anxiety about school exams or moving house, generally sort themselves out over time, but it’s still important to be supportive and try to help ease their anxiety.
You should always consult your child’s GP for guidance on how to treat secondary enuresis.

BEDWETTING PRODUCTS

There are a range of bedwetting products on the market, which help reduce stress for both parents and children. If your child is old enough, discuss these products with them first and allow them to choose which ones they feel comfortable using.

DryNites Night Time Pants: These absorbent pants are designed to be lightweight and discreet, just like real underwear.
Mattress protector: A quality mattress protector is a good investment when your child is going through the bedwetting stage.
Disposable bedwetting mats: Absorbent bedwetting mats add an extra layer of protection and are a good option to consider if your child’s bedwetting has become less frequent and they don’t wear night time pants every night.
Night light: A night light can make your child feel more comfortable visiting the bathroom when it’s dark.

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