Nocturnal enuresis the child bed wetting is a common problem in childhood, which can also occur in teens and even adults. Urinary incontinence is characterized during sleep.
Your child sleeps so deeply that he does not wake up when he needs to urinate and therefore wet the bed two or three times a week. Time passes, he is older, but the problem continues.
The good news is that in most cases nocturnal enuresis infatil can be definitely monitored and cured by taking some measures.
Read on to learn more about this condition, its causes and what treatments are effective in overcoming the problem.
What is nocturnal enuresis?
It is involuntary urination while you sleep, something that is commonly known as “wetting the bed”.
It is important to know that nocturnal enuresis should be considered as a normal phase of the development of sphincter control if it occurs in children under 5 years of age.
In general, young children first learn to control their bladder and ask to pee during the day, while learning to wake up at night to go to the bathroom can take much longer.
Especially in men, nocturnal enuresis can continue to be present up to six or seven years and you should not worry about it.
If the problem continues after your child turns seven, then it is time to make a medical appointment to rule out other illnesses that may be causing involuntary urination at night.
Types of nocturnal enuresis
There are two types of nocturnal enuresis, and it is important to know what type is appropriate for your child’s case, as the causes may be very different.
- Primary nocturnal enuresis is one that occurs in children or adolescents who have always had this problem.
- Secondary enuresis is the one that begins after a period of six or twelve months of total control of urination, even at night.
Is this problem common? About us
It is estimated that approximately 10% of children between 4 and 6 years old wet the bed at night, perhaps not every day, but two or three times a week.
If we talk about older children or adolescents, the incidence drops to 1% or 3%.
It is not well known why, but nocturnal enuresis affects many more boys than girls.
Causes why does your child wet the bed?
Most cases of bedwetting are primary enuresis, ie children who have always had this problem.
There can be many possible causes. It may be that your child’s bladder is very small. Then, the amount of urine produced during the night is excessive for the size of your bladder, and so wet the bed.
Or maybe your son sleeps so deeply that he does not wake up when he feels like urinating.
Among the known causes of primary enuresis are the following:
- Delayed development of sphincter control
The maturation of nerve centers that allow your child to notice that his bladder is full may take some time. Not all children can identify this sensation at the same age, especially when they are asleep.
On the other hand, the urethra, the conduit through which urine exits to the outside, has two sphincters, one of voluntary control and one involuntary. The ability to voluntarily control this sphincter also depends on the neurological development of the child.
One of the possible causes of nocturnal enuresis is delayed maturation of these nerve centers.
- Genetic factors
It is known that nocturnal enuresis can be a frequent problem in certain families. If one parent had enuresis up to a certain age, there is a 40% chance that the child will not be able to control nighttime urination until about the same age.
If the problem of nocturnal enuresis occurred in both parents, then there is a 70% chance that the same thing will happen to the child.
Alterations of the anti-diuretic hormone
This hormone controls the amount of urine that is produced. Its level increases at night, decreasing the amount of urine produced in the kidney.
In some cases, there may be insufficient secretion of this hormone, which causes increased production of urine during the night. If the bladder is not able to retain as much urine, there may be nocturnal enuresis.
If your child has problems sleeping, sleeps a few hours, when he sleeps very deeply or has sleep apnea, these disorders could be related to his enuresis.
- Other possible causes
Although not frequent, bedwetting may be related to other underlying conditions such as neurological disorders, urinary tract infections, diabetes, or anatomical malformations at the level of the bladder, ureters, or urethra.
If your child has secondary enuresis, ie if you started to wet the bed again after a period of six months or more without wetting it, the cause is likely to be psychological.
When it comes to a small child, perhaps divorce from their parents, loss of a loved one or the arrival of a little brother can be stressful factors that can cause regression.
However, you should always consider the possibility of an infection, some other disease or even sexual abuse.
How Bedwetting Is Diagnosed
Well, as mentioned in previous paragraphs, if your child is more than seven years old and still wet the bed, it is time to consult the doctor, especially to rule out the presence of any disease.
The doctor will ask you questions about how often the child wets the bed, when to do it, whether to urinate well during the day, and other questions.
You will review your medical history and ask about your child’s family history.
You may also have a physical examination and urine tests to rule out a urinary tract infection.
Treatments for young children
Well, there are many steps you can take to help your child keep his bed dry all night long, there are even medications and alarms that can help him overcome the problem.
But the appropriate measures for each case will depend on the age of the child, whether previous treatments have failed or whether it is primary or secondary nocturnal enuresis, among other factors.
If your child is still small and has primary enuresis, these tips can help:
1-Do not punish him for wetting the bed
Control of urination at night does not depend on the child’s will, it is not that he is lazy or is trying to get attention; simply his nervous system has not yet matured enough.
If you punish him or scold him hard, the effect may be the opposite of what you want and your child may have low self-esteem in the future.
If you are embarrassed to wet the bed, reassure him that many people are the same and that is a problem that can be overcome. Tell him how his brother, father or uncle also wet the bed when they were little.
2-Reward it when you manage to keep your bed dry
Some parents use a chart where they mark the days when their child managed to control urination and those who did not. When a certain number of days are fulfilled, you can reward it with a candy, for example.
This certainly does not solve the problem of bed wetting overnight, but it can help.
3-Stimulates favorable habits
Encourage your child to urinate frequently during the day. You should not hold the urine for prolonged periods.
Try not to drink too much liquid at night, and make sure you go to the bathroom before bed. While this measure is unlikely to solve the problem definitely, it can certainly help dry nights be more than wet nights.
An exercise that can be helpful is to stop urination voluntarily when your child urinates during the day.
Finally, try not to drink cola or other caffeinated beverages at night, as caffeine often increases or accelerates the production of urine.
- Help him train his bladder
Training can help your child retain urine longer.
To begin, note the time each time your child urinates during the day. Then, calculate the time that passes between one time and the next.
After two or three days, tell your child to wait another 15 minutes before going to the bathroom again. For example, if you go every three hours, then try to start going every 3 hours and fifteen minutes.
You can gradually lengthen the waiting time. With this method your child can learn to hold urine longer and so may not wet the bed at night, but you have to be patient. Training can take several weeks to produce results.
Treatments in older children and adolescents
If your child is over nine or ten years old, or even if you are a teenager but suffer from primary nocturnal enuresis, these are some of the possible treatments.
1-Humidity sensing alarms
According to data released by the National Kidney Foundation, between 50% and 70% of children and adolescents with nocturnal enuresis respond to treatment with an alarm.
The device is placed in the underwear or on the mattress and sounds or vibrates when it detects humidity. So the boy wakes up and can go to the bathroom quickly before having completely wet the bed.
If your child does not wake up with the alarm, then you will have to wake him up. The idea is that you can wake up quickly to go to the bathroom, when urination has just begun.
Over time, the boy will begin to wake up when the bladder is full, before the alarm sounds, although this learning process may take several weeks or even months.
In some cases, the doctor may prescribe medications to keep the boy from wetting the bed at night.
Drugs such as desmopressin (which has a similar effect to the anti-diuretic hormone) help reduce the amount of urine produced at night and in this way, enuresis can be avoided.
The bad thing about this is that leaving the drug is likely to return bedwetting, because drug treatment does not help the patient control urination by him.
The Imipramine is a tricyclic antidepressant having a similar effect to desmopressin, but must be administered with caution due to possible adverse side effects.
3-Solutions for secondary nocturnal enuresis
If a child or adolescent begins to wet the bed after having had good control of urination for months or even years, then one should study very well what is the cause of this regression.
If the child has experienced a significant stress situation, such as the death of a loved one or the separation of their parents, it is probably a good idea to take him or her to a psychologist’s office.
And of course, medical consultation is also necessary to see if there is any infection, malformation or other underlying disease that may be the cause of enuresis.
In conclusion, it is important to remember that primary nocturnal enuresis is a common problem in children under 7 years of age, and usually resolves spontaneously, without any treatment.
Scolding him and punishing him will not help him control urination during the night.
If your child is over 7 years old and has nocturnal enuresis, you should consult your doctor to make sure there are no other diseases that can be the cause of incontinence.
And if it is secondary enuresis, then it is best to find out what caused the regression, to tackle the problem in the best possible way.