Nocturnal enuresis

Nocturnal enuresis, commonly known as bedwetting, occurs when a child urinates in bed while sleeping. Most children usually stop wetting the bed around 5 to 6 years of age. However, the age at which bedwetting becomes a problem varies from one family to another.

Nocturnal enuresis usually becomes a problem when it interferes with the child's ability to socialize. For some children and parents, it is associated with psychological consequences such as shame, embarrassment and guilt.

Causes and triggers

Bedwetting may be related to several causes. An underlying medical condition (e.g., diabetes, urinary tract infection) or a psychological problem may, in rare cases, be the cause.

In most cases, nocturnal enuresis is the result of one or more of the following factors:

• Genetics
• Deep sleep
• Constipation - the bowels put pressure on the bladder
• A small bladder or a bladder that is maturing more slowly

Also, boys are more likely to wet the bed.

Treatment

For most children, nocturnal enuresis resolves on its own over time. However, if the child is greatly impacted, there are solutions to help manage the situation. Since treatments require time and patience, the parents and the child must be very motivated when deciding to start treatment.

The child will require support from the parents throughout the process. A child who wets the bed does not do so voluntarily and should never be punished for wetting episodes.

First and foremost, start with these basic measures:

• Make sure that the child drinks more at the start of the day and during the afternoon and limit the amount of fluids in the evening.
• Avoid sugary drinks and those that contain caffeine (e.g., soft drinks).
• Remind the child to use the toilet before going to bed.
• Make sure that the child can easily locate the toilet at night (night light in the hallway or bathroom).
• Protect the mattress with a waterproof pad and add a towel under the sheet for greater absorption.
• Ask the child to help with morning bed clean-up, including removing and washing the sheets and pajamas to help hold them accountable.
• Help the child wash in the morning to avoid unpleasant odours.
• The use of training pants should only be used for special occasions, such as overnight visits with family or friends since these may prevent the child from wanting to get out of bed.

With younger children, motivational therapy is often a great way to start. This technique involves keeping a record of the child's progress. You could, for example, put a sticker on a calendar for each dry night. The parents and the child should agree on the reward based on the length of time that the child does not wet the bed.

A special bedwetting alarm can also be used to control nocturnal enuresis. These devices sound an alarm (or vibrate) as soon as the sensor detects the first drops of urine, thereby training the child to wake up when the bladder is full. Initially, the parents may have to wake the child when the alarm goes off, but the child will eventually learn to wake up on their own. This approach is usually very effective in children older than seven years of age.

Lastly, the use of certain medications can be considered if the basic measures, motivational therapy or bedwetting alarm do not yield satisfactory results after three to six months.

When should I see a healthcare professional?

See your healthcare professional if your child:

• Does not experience satisfactory results with the measures described above
• Wets the bed after at least six months of being dry
• Wets their underwear during the day
• Needs to urinate frequently or urgently
• Is extremely thirsty during the day
• Experiences burning when urinating

For more information:

• Canadian Paediatric Society