Nocturnal enuresis

Is your 6-year-old wetting the bed? Nocturnal enuresis, or bedwetting, is a common problem for children. Bedwetting often goes away on its own, but learn how things like patience and a bedwetting alarm can help you and your child get there faster!

What is nocturnal enuresis (bedwetting)?

Nocturnal enuresis (bedwetting) refers to involuntary urination during sleep. This condition mainly affects children aged 5 to 6 years and occurs in boys more often than girls. Children are considered to have nocturnal enuresis when they wet their beds more than 2 times a week after the age of 5. There are 2 types of nocturnal enuresis: primary enuresis and secondary enuresis.

Primary enuresis

In this case, the child hasn’t yet reached control of urination at night. Primary enuresis is often caused by a problem with the bladder (e.g., an anatomical problem, small bladder) or an external disorder such as hyperactivity, which occurs more often in boys.

The cause can also be hormonal, for example, if the child doesn’t produce enough antidiuretic hormone. This hormone decreases the production of urine at night. When not enough antidiuretic hormone is secreted, urine production then increases. Sometimes, children sleep so deeply that the need to pee doesn’t wake them up. An emotional problem can also cause bedwetting. In most cases, a combination of these different factors is the cause of primary enuresis.

Secondary enuresis

Secondary enuresis is when children start wetting the bed again after at least 6 months of staying dry at night. Secondary enuresis is mainly caused by an emotional problem, such as the reaction to a divorce or a new child in the family. It can also be caused by a urinary tract infection, an obstruction of the urethra, or diabetes.

Bedwetting has a very strong hereditary component. If one or both parents wet the bed when they were young, their child will have a good chance of doing so too.

Bedwetting isn’t an illness but rather a stage that children have to get over. It usually goes away on its own, and about 99% of children don’t wet the bed by age 15.

When involuntary loss of urine happens to adolescents and adults, this is instead called incontinence, a broader term that encompasses urinary loss during not only sleep but other situations too.

Patience and persistence

Nocturnal enuresis isn’t a behaviour problem, and children don’t wet the bed intentionally. Punishing them would therefore be unfair and do nothing to solve the problem. Wetting the bed is frustrating and painful for children too, and it can affect their self-esteem. You therefore need to avoid blaming them.

Getting your child over bedwetting requires patience and persistence. A total control of urination at night rarely happens on the first try. However, simply reducing bedwetting episodes can have a positive effect on your child’s self-confidence.

Motivational therapy

Motivational therapy is very effective. This reduces the number of episodes in nearly 75% of cases and completely stops bedwetting for 1 out of 4 children. Active participation and persistence from both parents and the child are what will create the best chances for success.

Here are some ideas or tips that can help you:

• Encourage your child and reinforce your child’s self-esteem. Avoid ridicule or blame. 
• Make a calendar of stickers for each “pee-free” night.
• Get your child involved in changing sheets and pyjamas, without this being a punishment.
• Get your child to wear training pants or normal underwear instead of diapers.
• Avoid liquids after dinner and remind your child to pee before going to bed.
• Teach your child to take his or her time, relax and use the right position when urinating (feet flat on the floor or on a stool so that the bladder empties completely).
• Keep a night light on in your child’s room and in the hallway to the bathroom or put a potty in his or her room.

Bedwetting treatments

Since bedwetting isn’t a disease, it usually doesn’t require medical treatment and goes away on its own as children grow. However, some children may benefit from a bit of help, especially if they’re over the age of 6 and wetting the bed is embarrassing, e.g., when they visit family or friends or go to camp. In this case, your doctor may advise conditioning treatment (bedwetting alarm) or medication.

Conditioning treatment

A bedwetting alarm is the most efficient conditioning treatment system. This electronic device senses moisture, which triggers an alarm (a sound or vibration) that wakes children up as soon as urine wets their underwear or pyjamas. The alarm helps children learn to feel when their bladder is full and when they are about to wet the bed. This system is effective in about 50% of cases. The best results are achieved after 6 months of conditioning.

You’ll have to test it for 6 to 8 weeks to see whether this method is effective for your child. If it doesn’t give you results at first, try again. A second try may go more quickly, particularly if your child is motivated. Encouraging your child and actively participating in the treatment will increase the chances of success. If the bedwetting alarm works, continue for 14 consecutive nights without bedwetting before you stop your child from using it.

Medications

The two drugs most commonly used to treat bedwetting are Tofranil™ (imipramine) and DDAVP™ (desmopressin, an analogue of antidiuretic hormone). Their mechanisms are completely different, so if your child doesn’t respond to one, he or she may respond to the other. You’ll need 3 to 9 months to see of these drugs resolve the problem.

Drugs are effective in about half of cases. If your child responds positively to the treatment, it is important to stop the drug gradually to avoid a relapse. About 50% of children relapse after they stop taking their medication.

One benefit of these drugs is that they work quickly right away, which means they’re good options for sleepovers.

Which of the two drugs you choose will depend mainly on their side effects, cost and form (Tofranil comes in tablets, while DDAVP is available as a nasal spray and dissolvable or swallowed tablets). Your doctor or pharmacist can advise you on the best medication for your child based on his or her characteristics and your preferences. Learn more about the benefits and drawbacks of medications before making a decision.

Bedwetting can affect the quality of life of not just your child but your whole family. However, this temporary problem can be resolved with conditioning or medication. To find out which solution is best for your child, talk to your pharmacist or doctor.