What Causes Secondary Nocturnal Enuresis in Children?

A child learns bladder control at a young age. It can, therefore, be shocking and alarming when they experience leaks at a much older age.

The relapse of this process is called Secondary Nocturnal Enuresis. In comparison to Primary Nocturnal Enuresis, children with SNE are often not born with a chronic health problem or developmental disability. Whilst it is a shock to parents, children can also see their social lives suffer from having this. Sleepovers with friends and school camps can become a source of considerable stress to a child. They may also be worried about judgment from peers of their own age.

When Should I Be Concerned?

If your child is experiencing regression, however, was once previously fully dry overnight, it is recommended that you talk to a professional. Do not worry too much or jump to conclusions, as in many cases this can be due to a small lifestyle change. The National Association for Continence asserts that most children should have achieved urinary control during the night and day by the age of 6. If your child is aged 6 or older and is having problems with staying dry, you are advised to speak to a professional. Urologists are medical Doctors with specialist training and skills in problems related to the kidneys, bladder and genitalia. They have special training and skills in kidney, bladder and other related problems that affect children.

What Could Be Causing This?

In many cases, factors such as family life changes and important events are to blame for Secondary Nocturnal Enuresis episodes in children. Psychological stress has been shown to be associated with wetting the bed after gaining continence. Studies have outlined many important comorbidities between a child’s neuropsychological dysfunctions and wetting the bed. Many experts feel that these problems can be attributed a common central nervous system involvement. Leaking is often a regressive symptom in response to stress or trauma. Similarly, problems with hormones is another common, overlooked cause of Secondary Nocturnal Enuresis. A hormone named Vasopressin informs the kidneys to produce less urine at night. Many children produce a deficient amount of this vitamin, which causes complications. Overnight these children have significantly low levels of this hormone, which is designed to concentrate the urine at night.

A common temporary factor that can cause SNE is constipation. Surprisingly, when a child has excessive amounts of stool in their rectum, it can push against the bladder and confuse nerve signals. This causes the body to think that the bladder is fuller than it actually is. Another complication of this is that a full rectum can reduce how much urine the bladder can hold and how efficient the bladder is at emptying. Constipation is often the most overlooked cause of Secondary Nocturnal Enuresis, however talking to a Doctor about how to improve this can often make all the difference.

Other underlying health conditions such bladder infections are other common factors that can cause Secondary Nocturnal Enuresis. A large fraction of children with Secondary Nocturnal Enuresis are affected by bladder infections. In fact, it has been found that 15-20% of children with a bladder infection suffer from Secondary Nocturnal Enuresis. Another condition that is common in children with SNE is Diabetes, which causes excessive amounts of urine and heightened thirst. Having structural problems or a small bladder capacity can heighten this problem.

What Do I Do Next?

The way you approach your child about their leakages is extremely vital. Studies have shown that making a child feel guilty can make bed wetting even worse. Try and avoid losing your temper and instead focus on finding a solution. Some medical conditions are easy fixes and leaking can disappear with a course of antibiotics. However, it is still vital to take your child to have a physical examination with a pediatrician. Their urine will be examined for signs of a disease such as Diabetes.

A study in 2016 showed that motivation therapy works as a first-step treatment for children with Nocturnal Enuresis. This method is often recommended for children who are within the age group of 6-8 and do not have an intense amount of bed-wetting at night. During this treatment method, praise and other rewards are used to help a child regain bladder control. Specialists recommend that you provide large awards for longer compliance with good behaviour. Recent studies found this method to be successful in 25 percent of children, leading to complete improvement in more than 70 percent of children.

As the child gets older, many people invest in bed wetting alarms to prevent leakages. Alarms are designed to help children form a habit and train their bladder. In some cases, alarms can be supplied by your healthcare service. You should assess the response to an alarm by 4 weeks and continue with treatment if the child is showing early signs of response. Before you trying the alarm, discuss with your child what they should do when the alarm goes off, for example, change their pyjamas. It is recommended that you try this method until 2 weeks of uninterrupted dry nights have been achieved.

Another vital lifestyle change is to assess your child’s diet to ensure the bed wetting is not triggered by bladder irritants. You should ensure your child does not consume a lot of caffeine or sugar in the evening. A lot of citrus juices and liquids with artificial flavourings can also be a trigger.

You should also bear in mind that your child may require medication. If your child is lacking in Vasopressin, an artificial form, called Desmopressin is often prescribed. A Doctor can help you find the ideal treatment option for your child. Remember that in most cases, the condition can be helped. Patience and the help of a specialist are vital.