Causes and treatment for nocturnal enuresis

Children over 3 years of age generally do not pee in bed anymore, but it is normal for the child to still pee in bed on some nights until around 5 years of age. From then on, the child should be able to identify the desire to go to the bathroom day and night and not wet the bed anymore.

From 4 years of age, parents should be aware that the child is able to hold the pee during the day and also during the night, making sure that he does not pee in bed whenever he wakes up in the morning.

When to worry

It can be a cause for concern if the child is over 4.5 years old and holds the pee well during the day, but still pee in bed every night or more than 2 times a week. In that case, the pediatrician should be warned because these are several causes for this to happen.

A common cause is that the child drinks a lot of liquids after 6 pm and does not pee before going to bed, another common cause is that the child is anxious, afraid and does not want to get out of bed to go to the bathroom, but sometimes, bed wetting can be caused by a condition called nocturnal enuresis, a type of childhood urinary incontinence.

The child should not be blamed for bed wetting, however enuresis needs specific treatment, which may include urine training, use of special pajamas or even use of medicines indicated by the pediatrician.

Main causes of enuresis

Any child up to 8 years old can pee in bed at night if they drink a lot of water after dinner or do not go to the bathroom before sleeping, but this situation must be rare and must be associated with these factors.

If the child frequently pees in bed, the causes may be related to:

Growth retardation - children who start walking after 18 months, who do not control their stools or have difficulty speaking, have a greater chance of not controlling their urine before the age of 5; Mental problems - children with psychiatric illnesses like schizophrenia or problems like hyperactivity or attention deficit, are less able to control urine at night; Stress - situations like separation from parents, fights, birth of a sibling can make it difficult to control urine at night; Diabetes - the difficulty in controlling urine can be associated with a lot of thirst and hunger, weight loss and altered vision, which are some of the symptoms of diabetes.

There are 2 different types of the disease: primary enuresis occurs when the child has always needed diapers to avoid bedwetting, and secondary enuresis occurs when for some reason, after the child is able to control the pee well at night, it returns peeing in bed.

How to identify enuresis

Parents may be suspicious when the child is 5 years old and still peeing in bed or when he pee in bed again after spending more than 6 months on urine control. But for the diagnosis of enuresis, it is necessary to go to the doctor to do some tests, such as urine test, ultrasound of the bladder and, in some cases, perform a urodynamic test to study the storage, transport and emptying of urine.

6 steps to help your child avoid bed wetting

The treatment of nocturnal enuresis is very important and should be started as soon as possible, especially between 6 and 8 years of age, to avoid problems such as social isolation, conflicts with parents, situations of bullying and decreased self-esteem, for example. Thus, some techniques that can help cure enuresis include:

1. Maintain positive reinforcement

The child should be rewarded on dry nights, which are those when he is able to not pee in bed, receiving hugs, kisses or stars, for example.

Award for not peeing in bed

2. Train urine control

This training should be done once a week, to train the ability to identify the sensation of a full bladder. For this, the child should drink at least 3 glasses of water and control the urge to urinate for at least 3 minutes. If she can take it, next week she should take 6 minutes and the next week, 9 minutes. The goal is for her to be able to go without peeing for 45 minutes.

Urine control training

3. Waking up at night to pee

Waking the child up at least 2 times a night to pee is a good strategy for them to learn to hold the pee well. It can be useful to pee before going to bed and set an alarm to wake up 3 hours after bedtime. Upon waking up, one should immediately go to pee. If your child sleeps more than 6 hours, set the alarm clock for every 3 hours.

Waking up at night to pee

4. Take medicines indicated by the pediatrician

The pediatrician may recommend the use of medications, such as Desmopressin, to reduce urine production during the night or taking antidepressants such as Imipramine, especially in case of hyperactivity or attention deficit or anticholinergics, such as oxybutynin, if necessary.

5. Wear sensor in pajamas

An alarm can be applied to pajamas, which make a sound when the child pees in the pajamas, which makes the child wake up because the sensor detects the presence of pee in the pajamas.

Use a urine sensor

6. Perform motivational therapy

Motivational therapy should be indicated by the psychologist and one of the techniques is to ask the child to change and wash his pajamas and bedding whenever he pees on the bed, to increase his responsibility.

Usually, the treatment lasts between 1 to 3 months and requires the use of several techniques at the same time, and the collaboration of the parents is very important for the child to learn not to pee in bed.