Nocturnal Enuresis in Children: Causes, Diagnosis & Treatment
It’s 2 am, and you find out your child’s bed is wet again. “What might be the reason behind this?” “Is it something in his diet?” “What treatment options might help with this?” These questions start to cross your mind. But it’s not something you did or something your child is doing. Nocturnal enuresis is simply a medical condition. About 20% of five-year-old children experience bedwetting at night. Nocturnal enuresis in children is more common than one might think. But here’s some good news: it is completely reversible. With the right treatment approach, you can help your child gain back their lost confidence and restful sleep. For more information relating to symptoms, causes, diagnosis, medications, and more, continue reading further.
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What Is Nocturnal Enuresis and Its Types?
Nocturnal enuresis involves involuntary urination during sleep, often diagnosed when a child becomes 5 years old. While the condition is generally seen in boys, it exists in both genders.
Timely intervention for the treatment of nocturnal enuresis is often suggested. If not, troubles can exist even in an adult’s life.
Different types of nocturnal enuresis in children:
- Primary Nocturnal Enuresis: This is considered a more extreme form of nocturnal enuresis. The doctor might ask questions about whether the child has ever achieved complete dryness. Linkage to genetic factors is of importance here. Details related to delayed bladder maturation, small bladder capacity, urine continence, and other issues are often noted. Children here frequently wet their beds and might not face troubles in other areas.
- Secondary Nocturnal Enuresis: Here, the child experiences no bedwetting issues for a minimum of 6 months. Infections, stress, sleep disturbances, or other underlying health issues can be the cause of this type of nocturnal enuresis in children.
What Are the Symptoms of Nocturnal Enuresis?
- Improper Sleep: Sleep disturbances may frequently occur. Children who have a deep sleep, in particular, find it difficult to wake up as their bladder becomes full. Restlessness or even snoring might be noticed.
- Daytime Urination: Having an urge to pee frequently, difficulty holding urine, and other similar troubles can be reported even during the day.
- Emotional Indicators: Bedwetting affects the emotional state of a child. Feelings related to guilt and shame can slowly eat at his confidence levels. Parents need to play an active role in noticing these subtle changes in their behaviour.
- Physical Changes: Changes such as skin irritation or rashes around the private areas are noticeable. Waking up in soiled clothes can often be discomforting. Children may even wake up halfway through their sleep.
Other Symptoms Associated with Nocturnal Enuresis:
- Constipation: Due to pressure from a full bowel, even constipation can cause nocturnal enuresis.
- UTIs: UTIs are frequently known to worsen a child’s bedwetting episodes.
Causes of Nocturnal Enuresis in Children
There isn’t a single cause that leads to nocturnal enuresis. It is often a combination of factors that causes nocturnal enuresis in children.
- Genetic Factors: Even if one of the parents experiences nocturnal enuresis, their children have a 40% chance of inheriting it. This chance further increases to 70% if both parents had this condition in their childhood.
- Delayed Bladder Maturation: In some children, the brain-bladder communication develops more slowly. Although with age, some children naturally tend to overcome this ability.
- ADH Deficiency: ADH stands for antidiuretic hormone. The secretion of this hormone happens at night. When these levels of ADH are low, it becomes a cause for nocturnal enuresis in children.
- Smaller Bladder Capacity: When you have a small bladder, it becomes difficult to hold the urine produced at night.
- Stress and Underlying Medical Conditions: Emotional stress, such as parental conflict or the arrival of a new sibling, can contribute to bedwetting. In some cases, underlying medical conditions like urinary tract infections may also be associated with nocturnal enuresis.
How Is Nocturnal Enuresis Diagnosed?
The evaluation of nocturnal enuresis in children by doctors usually involves the following steps:
- Detailed Medical History: This forms the first step in ensuring your child’s well-being. The more detailed a medical history is, the better it is. Information about family history, frequency, and others is noted.
- Physical Examination: A physical examination is necessary to rule out any other complications.
- Bladder Diary: The parent can maintain a diary with details about fluid intake, urination times, and bedwetting frequency.
- Urinalysis and Laboratory Tests: Urinalysis is a commonly followed procedure to rule out UTI, diabetes, kidney disorders, or any other types of illnesses. Blood tests to find any hormone abnormalities may also be evaluated.
In some cases, doctors may also check for structural or functional urinary tract issues such as bladder outlet obstruction, which can lead to similar symptoms. You can read more about this condition in our detailed guide, Bladder Outlet Obstruction in Children.
Other tests, such as ultrasound, post-void residual urine test, uroflowmetry, and MRI of the spine, can be recommended by your doctor.
What Are the Treatments for Nocturnal Enuresis?
Expert-recommended bedwetting treatments for nocturnal enuresis include:
- Behavioural Changes: Small lifestyle changes can create a massive impact. Parents should limit their child’s fluid intake one to two hours before bedtime and encourage regular bathroom breaks two to three times during the day.
- Bladder Training Exercises: Bladder training exercises to improve bladder control can be taught to children.
Medicines Prescribed for Bedwetting Treatments:
- Desmopressin (DDAVP): Options to take desmopressin exist in both tablet and melt form. These are an excellent treatment option for nocturnal enuresis, as they mimic the production of natural ADH to reduce urine production.
- Imipramine: Imipramine is a tricyclic antidepressant that creates changes in both bladder muscle and deep sleep patterns. Just ensure that this treatment option for nocturnal enuresis is under the supervision of a doctor. You can contact an experienced healthcare professional to check for any side effects associated with this medication.
- Anticholinergic: These are prescribed if the child has a small or overactive bladder.
How Can Parents Help Children Cope with Bedwetting?
The vital role parents play in a child’s life to help them overcome bedwetting includes:
- Emotional Reassurance: Reassure your child that bedwetting was not their fault. This also helps to lower their anxiety, which indirectly affects bedwetting.
- Following a Consistent Bedtime Routine: Habits like sleeping and waking up at the same time should be encouraged. Reduce negative habits of your child, such as playing video games just before their bedtime.
- Limit Fluid Intake Before Bedtime: Slowly reduce your child’s water intake 1 to 2 hours before their bedtime.
- Use of Protective Bedding: The use of waterproof sheets will make the cleaning process quite easy. With protective bedding, your child can sleep comfortably, knowing it’s okay even if the bedwetting occurs.
- Reward System: A reward system can be implemented when the child uses the toilet daily at a fixed time. The use of stickers is another trick that works well with children.
- Use of Bedwetting Alarms: Bedwetting alarms alert the user when they detect any moisture levels. Children usually become comfortable with bedwetting alarms after some time.
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Conclusion
Navigating nocturnal enuresis in children can be emotionally challenging, but it does not have to be. With the right approach, nocturnal enuresis in children is always treatable. Just some small tweaks guided with empathy could work wonders for your child. As with other conditions, knowing the cause will be the first step that you can take for your child. Dr. Gursev, an expert paediatric surgeon, offers evidence-backed, personalised care. Contact us to learn more about effective treatment options for your child. Whether it’s about bladder control, sleep disturbances, or urinary incontinence, we are here to assist you. Don’t hesitate and engage in early intervention to see your child shining with confidence today.
