Nocturnal enuresis in children: when and why do children pee in bed?
Waking up in the morning and finding your child has wet the bed is the typical manifestation of what is called nocturnal enuresis: a problem most frequently encountered in children
What is nocturnal enuresis?
A child who suffers from enuresis is unable to perceive and control urination correctly and consequently manifests an involuntary loss of urine that occurs during sleep.
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Enuresis, in fact, can be
- nocturnal, when the phenomenon is contextualised in the evening hours of rest;
- diurnal, when it affects daytime hours;
- mixed, when it affects both.
The classification also includes a distinction between
- primary enuresis, if the subject has never achieved control of bladder continence;
- secondary enuresis, if it occurs following the acquisition of bladder control.
Symptoms of nocturnal enuresis
To be classified as such, the enuresis disorder must occur with repeated and prolonged frequency: 2 or more times a week and for at least 3 months.
A distinction that must also be made is between
- monosymptomatic enuresis: the form that has no other symptoms;
- polysymptomatic enuresis, the form accompanied by a symptomatology that may include: the need to urinate frequently and urgently; a combination with faecal incontinence or constipation (the full bowel decreases, in fact, the capacity of the bladder).
Causes
- physiological
- neurological;
- hormonal.
The psychological aspect also plays an important role, particularly in secondary forms.
By way of summary and example, the following causes of the disorder can be identified
- Familiarity: if one or more of one’s family members have suffered or suffer from enuresis, there is often a tendency to develop the disorder;
- emotional and/or psychological problems such as anxiety, stress;
- sleep disorders: difficulty waking up in certain stages of sleep to respond to the urge to urinate; poor quality sleep that may also include the presence of sleep apnoea caused by adenoid hypertrophy (an increase in the size of the adenoids that can cause airway obstruction, ed;)
- polyuria: an abnormal and excessive production of urine;
- delayed development of diuresis regulation mechanisms such as endocrine disorders that can result in a deficiency of the antidiuretic hormone vasopressin (or ADH), which causes the amount of urine produced to be much smaller during sleep than during the day;
- incomplete or delayed development of the bladder and its containing capacity;
- anatomical-functional dysfunctions of the urinary tract;
- urinary tract infections;
- overactive bladder;
- problems and/or disorders of the nervous and muscular system;
- diabetes mellitus;
When to consult your doctor
Nocturnal enuresis can be considered a normal phenomenon up to 5 years of age: a period when children may not yet have reached complete autonomy and mastery of urinary continence.
In the case of persistence beyond this age, a medical check-up is necessary to exclude other underlying problems and to allow the most appropriate therapy to be set up.
Diagnosis of nocturnal enuresis
In addition to the objective examination, through which the doctor has the opportunity to assess the lumbosacral region, the genital area and the abdominal area of the child, simple laboratory tests of urine and blood can be prescribed, capable of diagnosing pathologies such as infections, diabetes, endocrine deficiencies.
An ultrasound scan of the urinary apparatus, to rule out anatomical abnormalities or incomplete bladder emptying, also completes the normal diagnostic pathway.
Only when, following the ultrasound, an anatomical and/or functional problem is hypothesised, can more specific investigations be prescribed, such as urodynamic examinations (invasive and non-invasive), which can assess urinary function and the presence of any abnormalities (uroflowmetry, cystometry, bladder residual study, etc.).
Generally, a diary is also made to record the urination habits of the child affected by enuresis in which the patient and parents record for a few days
- time of urination
- urination volume (with the help of containers or nappy weight);
- associated symptoms such as urinary leakage or urinary urgency;
- amount of fluid intake.
The consequences
Nocturnal enuresis is a problem that in childhood in the majority of cases is not determined by particular pathological problems and that tends to resolve itself during childhood: only a very small percentage of patients remain enuretic even after adolescence.
The psychological-emotional aspect of this disorder must never be overlooked, as nocturnal enuresis can have negative effects on self-esteem; it can trigger depression and discouragement in the young patients affected and in their families.
Remedies for nocturnal enuresis vary depending on the triggering causes, be they psychological and/or physical
If, for example, the child suffering from it is diagnosed with diabetes, it will be necessary to act on this with an appropriate therapy, just as, on the other hand, it may happen that constipation is detected, which, by reducing the bladder space, will require a different diet, etc.
Some measures against nocturnal enuresis that may be indicated in general are
- maintain adequate hydration throughout the day, with attention to a reduction in the evening hours, also avoiding the consumption of drinks and exciting foods (caffeine, tea, chocolate);
- avoid eating foods particularly rich in liquids, salt and sugar at dinner: follow a balanced diet, but limit the consumption of minestrone and vegetable purée during the evening meal, also avoiding milk and dairy products due to their high calcium content and foods containing a lot of sugar (e.g. sweets, candies) and salt (cold cuts, anchovies etc.)
- performing bodily functions (urination and evacuation) regularly throughout the day and especially before going to bed.
New technologies, then, provide further precious help, as some latest-generation devices (nocturnal alarm for enuresis), equipped with special sensors, allow the detection of urine leakage in the sheets or underwear, emitting an acoustic signal that wakes the subject to go to the bathroom.
These devices are particularly useful because they also implement a psychological conditioning process at an unconscious level.
Medications against nocturnal enuresis
If, on the other hand, the specialist needs to prescribe a pharmacological therapy against enuresis, various drugs may be indicated, the most commonly used in children being
- desmopressin: the synthetic form of the antidiuretic hormone vasopressin (or ADH) which, taken orally (sublingual tablets), supplements its incomplete or lack of production by the body, causing the body to produce less urine at night;
- anticholinergics, i.e., drugs that limit or prevent the activity of acetylcholine neurotransmitter receptors in the nervous system, acting on the bladder muscles, promoting their ‘relaxation’ (oxybutyn hydrochloride) and increasing their capacity.
The watchword is ‘understanding
An understanding attitude towards children suffering from nocturnal enuresis is essential as, especially in the primary form, there is no voluntariness of the act.
A reproach to a child for wetting the bed, for example, can be associated by him with the event in a traumatic way, leading to embarrassment and mortification that can make the psychological and emotional burden linked to enuresis even more important.
It is good to remind oneself or one’s children, positively and calmly, that this is a well-defined pathology and that, as such, there is the possibility of tracing the triggering causes and finding a solution.
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