Secondary Enuresis – Bedwetting Is Not a Laughing Matter

Dr. Greene`s Answer:

You are right, bedwetting is not a laughing matter — for nearly 6 million people in the United States alone. Not only is there a social stigma attached to bed-wetting, but it causes great inconvenience due to the extra laundry that must be washed in a timely fashion (even if the person responible for doing the laundry doesn’t have time), and, most importantly, bed-wetting interrupts sleeping patterns and causes scores of problems associated with sleep deprivation.

Bed-wetting is broken down into two distinct categories, Primary Nocturnal Enuresis and Secondary Nocturnal Enuresis. The two conditions are very different. Primary Nocturnal Enuresis (PNE) is the term used to describe the condition of individuals who have achieved daytime bladder control, but have not been able to achieve nighttime bladder control for at least six consecutive months. I have discussed both causes and treatments of Primary Nocturnal Enuresis at length in other answers. Secondary Nocturnal Enuresis (SNE) is the term used to describe the condition of an individual who has achieved nighttime bladder control for at least six months, and then begins bed-wetting again.

From your description, I believe you fall into the category of Secondary Nocturnal Enuresis. In SNE the big question is, “What has changed?” At one point you were able to achieve nighttime bladder control, so something must be different. The possibilities include some physical problem such as a urinary tract infection (even a low-grade infection that doesn’t seem to impact your life can trigger bedwetting) or the onset of a disease such as diabetes, or some emotional stress like starting a new term in school, or something as simple as a change in sleep habits.

When you had stopped bedwetting, did you sleep straight through the night, or did you need to wake up to go to the bathroom? If you slept straight through the night, but now wet the bed, the problem is more likely related to recently increased urine production. If you have always needed to urinate at night, but have recently not woken up for this, the problem is more likely related to increased difficulty waking up — from stress, shifting bedtimes, or low-level sleep deprivation.

Whenever bedwetting starts after a period of at least six months of nighttime control, it is important to have a thorough physical exam. Be sure to tell your physician the real reason for the visit so he or she can run the appropriate tests. If your physician doesn’t seem to be concerned about the problem, you will want to seek a second opinion from a doctor who is skilled in the treatment of enuresis. Secondary Nocturnal Enuresis has helped me diagnose both minor and serious underlying physical problems that might have otherwise gone undetected.

Consider carefully whether you are consistently getting enough sleep. Some bedwetters will stop wetting the bed with as little as 30 extra minutes of sleep per night. Going to sleep at the same time every night, and not getting overtired, both make it easier to wake up when your bladder gets full. Changing sleep patterns are the most common reason (and solution) for SNE at your age.

At the same time, examine your life for new or heightened levels of stress. Common stresses include the death of a close friend or family member, parental divorce (especially if the individual involved is still living at home), a romantic breakup, a difficult roommate situation, school deadlines, job-related stress, etc. Everyone experiences stress at times, and everyone has ways of dealing with it. Some ways are better than others.

Since you are in college and have a roommate (who may make this situation very difficult if it is not dealt with quickly), I would suggest that you also seek counseling if stress is an issue. Again, look for someone who is sympathetic to your plight and who has a proven track record of helping people with SNE. He or she will be able to help you sort through your current situation and identify positive ways to cope with future stresses. Some of the ways you may find helpful in dealing with stress include exercise, massage, meditation, yoga, relaxation techniques, guided imagery, prayer, and forming close friends that you can really talk to. The important thing is to learn to be in touch with your emotions and take positive actions before the stress comes out through bedwetting.

Your doctor may recommend a medication to control bedwetting, such as the DDAVP tablet, in addition to identifying and treating the underlying problem that caused you to begin wetting the bed again. Because DDAVP has the potential for serious side effects, it should be used with caution and only under close supervision by a physician.

It is not surprising that I have received several questions from parents in the last month who are concerned that their children have started wetting the bed again after a prolonged period of nighttime bladder control. Many of them have stated that their child started school at about the same time the bedwetting started. These parents may have already uncovered the underlying reason for the problem, but should still take the children to their pediatricians for tests that rule out infection and disease. In addition, these parents can help their children deal with emotional stress using creative play and artwork.

I know that it is very difficult for most bedwetters to discuss their problem even with trained, caring professionals. The very fact that you asked this question leads me to believe that you will be able to overcome your hesitations and seek the help you both need and deserve.