What is Secondary Nocturnal Enuresis?
Secondary enuresis or secondary nocturnal enuresis (SNE) occurs when a child or adolescent has maintained proper control over their bladder during the night for a consecutive period of six months or more then begins to wet the bed again. Secondary enuresis accounts for approximately 25% of all bedwetting cases, with the number of children with secondary bedwetting increasing with age. Secondary enuresis often catches children and families by surprise and can be particularly distressing for all involved. Research conducted with children and teenagers report interpersonal relationship difficulties, a sense of hopelessness, as well as feelings of embarrassment and anxiety. If left unchecked, persistent bedwetting can lead to disrupted sleep patterns, as well as significant social and emotional difficulties. With secondary bedwetting, the first question parents need to ask is, “What has changed?” Your child had achieved nighttime continence and now wets the bed again. Secondary bedwetting appears to have two main causes:
Bedwetting results from a physical or medical condition
While physical causes of secondary bedwetting are rare representing 2-3% of all cases, any child who experiences a return to bedwetting after a significant period of nighttime continence should consult a medical professional to rule out the possibility of an underlying medical cause. A return to bedwetting has been linked with an unstable bladder or bladder dysfunction, urinary tract infections, diabetes, epilepsy, and chronic constipation, hyperthyroidism (overproduction of hormone by the thyroid gland), abnormalities in the nervous system, or injury or disease of the nervous system.
Bedwetting results from psychological stressors
The majority of secondary bedwetting results from emotional problems. All children react differently to stress. Signs of stress include physical symptoms such as ongoing headaches and stomach aches, vomiting as well as nighttime or daytime wetting. Stress reactions among children also include irritability, crying, emotional outbursts, increased aggression, fearfulness, and social withdrawal. While many of these behaviours may be mere characteristics of children’s personalities, the key indicator of stress is a change in children’s behaviour. For example, a child who is normally friendly and cheerful becomes sad and withdrawn or a child who was previously dry who suddenly begins to wet herself again, is probably showing signs of stress.
The three most common psychological stressors for children include the birth of a sibling, hospitalisation and starting school. Along with these three events other situations in a child’s life that may induce a stressful response resulting in secondary enuresis include social or peer relationship difficulties, bullying, child abuse or neglect, marital conflict, parental divorce or separation, problems with a teacher, anxiety about school (i.e., an upcoming test). You can help your child to manage stress by discussing with them what is bothering them. Discuss ways in which they can manage their stress, helping them to identify useful strategies. Help young children learn to find words to express their feelings, such as happy, sad, angry, or scared. Encourage children to find a physical outlet for their stress this may include energetic physical activities or relaxation techniques. Once the period of stress or the stressful situation has been resolved, children’s bedwetting usually stops.
Treating secondary nocturnal enuresis
The management of secondary nocturnal enuresis involves addressing the underlying cause. If your child’s bedwetting is the result of a medical problem, then the treatment will depend on the exact diagnosis. When there are significant emotional or social stressors associated with secondary bedwetting, then attention to these issues should take priority over the different treatments for bedwetting. Children with secondary nocturnal enuresis benefit from a caring, loving and supportive home environment in combination with formal counselling or psychotherapy. If there is no apparent underlying physical or psychological cause then the treatment options are the same as those recommend for children experiencing primary bedwetting.
It is particularly important to ensure that children get sufficient sleep and have a healthy balanced diet. Children who become overtired find it much more difficult to wake in response to a full-bladder. Among older teenagers and young adults alcohol and excessive caffeine from coffee, tea or high-energy drinks can increase an individual’s chances of wetting the bed. Many children who wet the bed drink small amounts of fluids throughout the school day, saving the majority of their fluid intake for when they arrive home from school. Parents can try and help children to become dry by ensuring they drink regularly throughout the day and encouraged them to use the bathroom every 1-2 hours during the day and immediately before they go to bed. The restriction of fluids is generally not recommended as this can lead to dehydration as well as increasing the risk of constipation.