Secondary Nocturnal Enuresis
Some children have always wet the bed at night, while others have not. In medical terms, bedwetting is called “enuresis.” Nocturnal (nighttime) enuresis is bedwetting that happens at night, whereas wetting during the daytime is called diurnal (daytime) enuresis.
There are two kinds of enuresis: primary and secondary. Someone with primary enuresis has wet the bed since he or she was a baby. Secondary enuresis is a condition that develops at least six months — or even several years — after a person has learned to control his or her bladder.
Secondary nocturnal enuresis (SNE) accounts for about one quarter of children with bedwetting. By age ten years, up to 8% of children will develop SNE. The number of children with SNE, as a percent of all cases of nocturnal enuresis, increases with age. A family history of bedwetting is found in about 50% of children with SNE.
The emotional impact of SNE on a child and family can be significant. Numerous studies report feelings of embarrassment and anxiety, loss of self-esteem, and adverse effects on self-perception, interpersonal relationships, quality of life, and school performance.
What causes SNE?
Doctors don't always know the exact cause of secondary nocturnal bedwetting. Some likely causes and contributing factors include:
- Sleep problems. The sensation of a full bladder causes most children to wake up in time to pee. But some children sleep so soundly they do not wake up to pee.
- Obstructive sleep apnea (OSA). Although uncommon, obstructive sleep apnea can also cause secondary nocturnal bedwetting. Large adenoids are the most common reason for sleep apnea that leads to SNE.
- Bladder problems. Some children have small bladders that can't hold a large volume of urine. Others may make too much urine at night. In some children, too many muscle spasms can prevent the bladder from holding a normal amount of urine.
- An overactive bladder (OAB). This is a common cause of SNE in the pre-school child. Children with an overactive bladder pee more than usual, often have to run to the bathroom, and are often wet during the day.
- Medical conditions. Bladder infections, constipation, and diabetes can also trigger secondary nocturnal enuresis. About 15-20% of children with a bladder infection present with SNE. Difficult, hard, or infrequent stools can cause or aggravate bedwetting. Children with diabetes can develop bedwetting because it causes excessive amounts of urine, as well as excessive thirst.
- Psychological stress. Some experts believe that stress can be associated with bedwetting. Many common situations can be stressful to children, such as birth of a new sibling, parental divorce or separation, death in the family, child abuse, or problems at school. The later the onset of the wetting, the more likely the cause is due to psychological stress.
- Hormonal problems. A hormone called antidiuretic hormone (ADH) causes the body to produce less urine at night. But some people's bodies don't make enough ADH, which means their bodies may produce too much urine while they're sleeping.
- Genetics. Children with enuresis often have a parent who had the same problem at about the same age. Scientists have identified specific genes that cause enuresis.
When to see a doctor
Children with secondary bedwetting should have complete physical examination with a pediatrician (a healthcare practitioner who specializes in children). A simple urine test (called “urinalysis”) will be done. In these tests, urine is examined for signs of a disease like diabetes. In most children with nocturnal enuresis, these test results come back completely normal. X-rays are usually not needed.
In addition to doing a physical examination, the doctor should take a complete medical history. This involves asking your child if he or she has any concerns, allergies, is taking any medications, has urinary symptoms (such as an urge to pee a lot, the need to run to the bathroom, or pain or burning during urination), or other issues. The physician should also ask about sleep patterns, bowel habits, past health, and family health. Finally, the doctor may discuss any stressful situations that could be contributing to the problem.
How Can I Help?
Children with SNE will benefit from a caring and patient attitude by their parents. There is no role for punishment and a positive approach is important to instill confidence and enhance compliance. Motivation is an important factor for success. Many of these children have "given up" on the concept of dryness and an optimistic attitude should be encouraged. Concentrating on normal voiding by day, not overdoing fluids in the hours before bed, and taking your child to the bathroom before bedtime and later before you turn in, can help with the wetting. Moisture alarm therapy and medications are available, and your healthcare provider can help you decide which approach is best.
If you would like more information, please contact us.
© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.