Nocturnal enuresis or bedwetting: understanding and helping your child

In collaboration with Rokiyah Hosen

Relecture professionnelle

Nocturnal enuresis or bedwetting affects 11% of children aged 5 to 7 and 2-3% of adolescents*. Between the ages of 2 and 4, toddlers are able to control their bladders during the day, but not systematically at night.Potty training can take several months or even years. As a result, some children still wet their beds after the age of 5. But what isnocturnal enuresis? And what can be done about it? Our investigation.

What is nocturnal enuresis?

Nocturnal enuresis, commonly known as "bedwetting", is aninvoluntary urination disorder that occurs during the night. The child urinates normally, but unconsciously while asleep. It is therefore not an childhood illnesslike gastroenteritis or chickenpox.

Talk ofenuresis before the age of 5 is premature. Before that age, it's more akin to a "little accident",since most toddlers have not yet acquired control of their sphincters. It's only when the child is still able to control his or her bladder that bedwetting can be diagnosed.

Nocturnal urinary incontinence can take two forms:

  • Primary enuresis, which concerns a child who has never been toilet-trained at night;
  • Secondary enuresis, which refers to a child who returns to bedwetting after a period of at least six months' cleanliness.

What causes nocturnal bedwetting?

The causes of nocturnal bedwetting are diverse. Depending on the case, they may be isolated or associated. Primary enuresis is often caused by a bladder that is too small, or by increased urine production during the night. Other physiological and psychological factors may also come into play.

Smaller-than-average bladder

If your child wets the bed, he or she may have a bladder that's a little too small. This low capacity causes violent urges to go to the bathroom. Children with this peculiarity urinate very often during the day. They may also leak into their pants. At night, they may wet the bed several times.

Excessive night-time urine production

Nocturnal polyuria corresponds to an increase in urine production during the night. It results from insufficient secretion ofantidiuretic hormone (ADH) during sleep. This disorder is often hereditary. Children with this condition are very good at going to the toilet during the day.

Other possible causes

Other factors can lead to nocturnal enuresis in children:

  • Enuresis occurs at the end of very deep sleep;
  • Genetic predisposition, a hereditary factor;
  • Incomplete toilet training (need for practice)
  • Lack of maturity of the bladder sphincters, such as concern for volume or reflex contraction (hyperexcitability and hypertonicity of the detrusor, the bladder muscle);
  • lack of nocturnal secretion of the antidiuretic hormone vasopressin
  • A regressive passage linked to an upsetting event (arrival of a little brother or sister, death of a close relative, failure at school, etc.);
  • Constipation problems;
  • Type 1 diabetes (rare).

What are the solutions for supporting your child?

As we've seen,nocturnal enuresis is not a childhood illness. The best solution is toaccompany and support your child in this stage of his development. While the causes of bedwetting are physiological, treatment with medication is possible.

Enuresis alarm or "pee alarm

Is your child over 6 years of age embarrassed by bedwetting? If so, you can suggest a "pee alarm" to help your child potty train at night.

The principle is simple: a probe placed on the underpants, pyjamas or mattress triggers a buzzer as soon as the first drops of urine are released. Eventually, this device will enable the child to wake up when his bladder is full andgo to the toilet on his own.

Note, however, that the sound of the alarm may disturb the sleep of other family members. If your child sleeps at a friend's house or goes to summer camp, this system may not go unnoticed.

Medication treatments

Before committing to medication, you can set up some useful little rituals. Explain to your child that he should avoid drinking too much in the evening, and remind him to go to the toilet before bedtime.

Nocturnal enuresis is a disorder that generally disappears with time. For this reason, it is not usually treated in children under 6 years of age. If the problem persists beyond this age, or your child shows signs of discomfort, you should consult a healthcare professional.

Your child's general practitioner or pediatrician will be able to identify the cause of bedwetting and prescribe a suitable treatment. If the bladder is too small, medication to increase bladder capacity can be administered. If too much urine is produced at night, your therapist may recommend the use of desmopressin.

Treatment of isolated primary nocturnal enuresis begins under two conditions:

  • If the child is over 6 years of age and motivated;
  • If general preventive measures fail for more than
    three months.

How can I help my child stop wetting the bed?

Does your child wet the bed, and would you like to help him or her? Here are 4 useful tips to help him manage this problem.

1. Support and reassure your child: bedwetting is normal!

Becausebedwetting is involuntary, it would be unfair to scold your child for wetting the sheets while he's asleep. Instead, adopt a positive, supportive attitude. Waking up soaking wet in the middle of the night can be frustrating and upsetting. Explain that peeing in the diaper or bed is perfectly normal, and that it happens to other children too. Ask your child what his night was like, what was different from nights with peeing, so that the brain registers the right parameters and continues.

For example: "I see your bed is dry, did you get up during the night to go to the toilet? If so, great you managed to feel your bladder calling you. If not, what did you dream about, were you hot or cold? Did you move around a lot?"

And based on what he answers, we can tell him that on nights when he pees, he feels the opposite, for example.

In this way, we give him the keys to his body.

2. Letting your child manage the situation independently

It's important for your child to remain in control of the situation, whether he's undergoing treatment or not. Invite him to take responsibility for his body. If he's still small, you can install a nightlight in his room so he can go to the bathroom by himself at night. If he's old enough, suggest that he write down on the family calendar the nights when he hasn't wet the bed. Finally, suggest that he helps change the sheets - without making it feel like a chore, of course!

3. Protect your child's sleeping space

To put your child at ease, remember to protect his sleeping space. You can install a waterproof mattress protector on the mattress, or place a bath towel under the fitted sheet to absorb urine. It's not necessary to change a sleeping child who has wet the bed, as this could disturb his sleep. Just make sure he has a spare pair of pyjamas to hand, which he can easily put on when he wakes up.

4. Choose training pants for babies

Potty training is a long, gradual process. Generally speaking, babies become toilet-trained during the day at around 2 years of age. So avoid putting your child in a disposable diaper at night if he or she no longer needs it during the day.

Instead, use waterproof underpads, put on a training pantsThey'll gain in autonomy and confidence. He'll be free to go to the potty on his own before bedtime, and will become more aware of his body and its needs.

FAQs on bedwetting

How to treat nocturnal enuresis?

Nocturnal enuresis is not an illness. This urinary incontinence disappears spontaneously, especially when the child is well accompanied. However, if your child is aged 5 or over, you can make an appointment with a healthcare professional to take stock of the situation.

Should I worry if my child still wets the bed?

No, you shouldn't! It's perfectly normal for toddlers to wet the bed. Children aged 2 to 4 often wet their sheets, as they don't yet have bladder control at night. From the age of 5 onwards, we speak of nocturnal enuresis. Once the cause has been identified, this urination disorder usually resolves itself.

Is bed-wetting normal after the age of 4?

Yes. As potty training is a longer or shorter process, depending on the child, bedwetting after the age of 4 is perfectly normal. Around 11% of children between the ages of 5 and 7 suffer from nocturnal enuresis, and 2-3% in adolescence.

Is bedwetting normal after the age of 8?

Yes, your child may suffer from nocturnal enuresis after the age of 8 due to a regressive episode or traumatic life event. It's important to pinpoint the origin of these episodes, so that you can work with your healthcare professional to suggest appropriate courses of action.