Nocturnal enuresis or bedwetting: understanding and helping your child

In collaboration with Rokiyah Hosen

Lood enuresis, or bedwetting, affects 11% of children aged 5 to 7, and 2-3% of teenagers*. Between the ages of 2 and 4, toddlers are able to control their bladders during the day, but not systematically at night. Lurinary 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?

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

It's premature to talk aboutenuresis before the age of 5. Before that age, we refer to a "little accident", since most toddlers have not yet acquired sphincter control. Only when the child is still able to control his or her bladder can bedwetting be diagnosed.

Nocturnal urinary incontinence can take two forms:

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

What causes nocturnal bedwetting?

The causes of nocturnal bedwetting are diverse. Depending on the case, they may be isolated or associated. LPrimary 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 who suffer from it are very good at going to the toilet during the day.

Other possible causes

Other factors can cause nocturnal enuresis in lchildren:

• Lenuresis occurs at the end of very deep sleep;
• Genetic predisposition, a hereditary factor;
• Incomplete potty training (needs practice)
• A lack of maturity of the bladder sphincters, such as a concern for volume or reflex contraction (hyperexcitability and hypertonicity of the detrusor, the bladder muscle);
• Deficient 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 can you do to support your child?

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

Enuresis alarm or "pee alarm

Is your child over 6 years old and embarrassed by bedwetting? You can offer him a "pee alarm" to help him potty train at night.

The principle remains simple: a probe placed on the child's 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.

Please 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.

Drug treatments

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

Lood 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 GP or pediatrician will be able to identify the cause of nocturnal enuresis and prescribe appropriate 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.

Treatments for isolated primary nocturnal enuresis begin under two conditions:

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

How can you help your child stop wetting the bed?

Does your child wet the bed, and would you like to help him/her? Here are 4 useful tips to help him deal with the problem.

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

Lecausebedwetting is involuntary, it would be unfair to scold your child for wetting the sheets during sleep. 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 when he peed, so that the brain registers the right parameters and carries on.

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

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

Here, she is given the keys to her body.

2. Let your child handle the situation independently

It's important for your child to remain in control of the situation, whether or not he's undergoing treatment. Encourage him to take responsibility for his body. SIf your child is still small, you can install a nightlight in his room so that he can go to the bathroom by himself at night. SWhen 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, of course, making it a chore!

3. Protecting your sleeping space

To put your child at ease, remember to protect his or her sleeping area. 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, so he can easily put them on when he wakes up.

4. Choose training pants for babies

Lransitioning is a long, gradual process. Generally speaking, babies become toilet-trained during the day at around 2 years of age. So don't put your child in a disposable diaper at night if he or she no longer needs it during the day.

Give preference to waterproof underpads, put him in a training pantsThis will give him greater independence and confidence. He'll be free to go potty on his own before bedtime, and will become more aware of his body and its needs.

FAQs on nocturnal enuresis

How can nocturnal enuresis be treated?

Should you sworry about your child wetting the bed again?

Is bedwetting normal after the age of 4?

Is it normal to wet the bed after the age of 8?