Nocturnal enuresis is the involuntary loss of urine during sleep in children over 5 years of age, with bed-wetting occurring at least twice a week, for at least 3 months, without any problem related to the urinary system having been identified. .
Nocturnal enuresis can be caused by an immaturity of the nervous system to control the bladder, genetic and psychological factors, or health conditions such as urethral obstruction, constipation, diabetes insipidus or overactive bladder, for example.
The treatment of nocturnal enuresis is carried out by a pediatrician and varies according to its cause, and bladder control training, avoiding water consumption before going to sleep or the use of medication may be recommended, for example.
Symptoms of bedwetting
The main symptom of nocturnal enuresis is children over 5 years of age wetting the bed while sleeping, waking up with their pajamas and bedding wet with urine.
These symptoms must occur at least twice a week, for at least 3 months.
Read too: Childhood urinary incontinence: what it is, symptoms, causes and what to do
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How to confirm the diagnosis
The diagnosis of nocturnal enuresis is made by the pediatrician by evaluating the symptoms, frequency of occurrence, how long the child has been wetting the bed, whether they were previously able to sleep without wetting the bed, the child’s habits, such as drinking water before sleeping, for example.
In addition, the doctor must assess whether there is a family history of nocturnal enuresis, the child’s health history and perform a physical examination.
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In addition, the doctor may order tests to identify or rule out health conditions that could cause nocturnal enuresis, such as urine tests, X-rays, kidney and bladder ultrasounds or urodynamic studies, for example. Understand how the urodynamic study is performed.
Types of nocturnal enuresis
Nocturnal enuresis can be classified into two types:
1. Primary nocturnal enuresis
Primary enuresis is characterized by the fact that children over 5 years of age have always needed diapers to avoid wetting the bed, as they have never been able to hold their pee during the night.
2. Secondary nocturnal enuresis
Secondary nocturnal enuresis appears as a consequence of some triggering factor, in which the child starts wetting the bed again after at least 6 months of urinary control.
Main causes of enuresis
The main causes of nocturnal enuresis are:
- Family history of nocturnal enuresis;
- Immaturity of the nervous system to control the bladder;
- Stress or anxiety;
- ADHD;
- Constipation;
- Diabetes mellitus or diabetes insipidus;
- Urinary infection;
- Sleep disorders.
Furthermore, nocturnal enuresis can occur due to a low bladder capacity to store urine, overactive bladder, cystitis or obstruction in the urethra, for example.
What to do
The treatment of nocturnal enuresis is very important and should be started as soon as possible with guidance from a pediatrician, especially between the ages of 6 and 8, to avoid problems such as social isolation, conflicts with parents, bullying situations and decreased self-esteem, for example.
Thus, some techniques that can help cure bedwetting include:
1. Maintain positive reinforcement
The child should be rewarded on dry nights, which are those when he is able to not wet the bed, receiving hugs, kisses or sparklers, for example.
2. Training urine control
This training should be done once a week, to train the ability to identify the sensation of a full bladder.
To do this, the child must drink at least 3 glasses of water and control the urge to urinate for at least 3 minutes. If she can handle it, next week she should be able to handle it for 6 minutes and the week after that, 9 minutes.
The goal is for the child to be able to go without peeing for 45 minutes.
3. Avoid giving liquids at night
Avoiding giving your child liquids at night is also a strategy to help cure bedwetting.
Therefore, it is recommended not to give water 2 hours before the child goes to sleep and dairy products at least 4 hours before the child goes to bed, in addition to encouraging the child to pee before going to bed.
4. Waking up at night to pee
Waking your child at least twice a night to pee is a good strategy for them to learn to hold their pee well. It may be helpful to pee before going to bed and set an alarm to wake up 3 hours after going to bed. When you wake up, you should immediately go pee.
If your child sleeps more than 6 hours, set the alarm for every 3 hours.
5. Wear a sensor on your pajamas
An alarm can be applied to the pajamas, which emits a sound when the child wets in the pajamas, which makes the child wake up because the sensor detects the presence of pee in the pajamas.
6. Take medications recommended by your pediatrician
Treatment with medication may be recommended by your pediatrician when behavioral changes and the use of an alarm have not been effective in improving bedwetting or if the child has a health condition that needs to be treated.
Generally, the doctor recommends the use of desmopressin to reduce urine production at night, used 3 minutes before the child goes to sleep, and can be associated with the use of an alarm in pajamas.
Furthermore, the doctor may recommend other medications when desmopressin was not as effective as expected, as in the case of oxybutynin or imipramine, for example.
7. Perform motivational therapy
Motivational therapy must be recommended by a psychologist and one of the techniques is to ask the child to change and wash their pajamas and bedding whenever they wet the bed, to increase their responsibility.
Typically, treatment lasts between 1 and 3 months and requires the use of several techniques at the same time, with parental collaboration being very important so that the child learns not to wet the bed.
