Secondary enuresis in children: definition and treatment

Secondary enuresis: definition

Enuresis, or urinary incontinence, refers to an uncontrolled emission of urine. Common in children, this bladder sphincter control disorder occurs most often at night. This is called nocturnal enuresis.

We design secondary enuresis like getting back to bed-wetting after a long time without a little accident like this. In other words, a clean child who no longer wears diapers but starts wetting the bed again is said to be bedwetting. 

Secondary enuresis most often has a psychological cause (change of environment or family upheaval for example), even if there are also pathological causes. 

What is the difference between primary and secondary enuresis?

Enuresis is said to be primary if it has not been preceded by an episode of cleanliness, a period when the child has been clean for at least six months. Primary enuresis is the most common form of enuresis.

When enuresis occurs after a period when the child has been clean, it is called secondary enuresis. This usually begins between 5 and 7 years old, but can also occur later, in adolescence for example.

Secondary enuresis: what treatment?

The treatment for enuresis, of course, depends on its cause. First, we will explore the possible medical causes. If a UTI is diagnosed, antibiotics will be prescribed. If diabetes is detected, adequate management will be undertaken. The same goes for possible malformations of the urinary tract. 

Finally, if no medical cause is detected, it is likely that secondary enuresis has a psychological cause. a Psychological support with a psychologist or a child psychiatrist may be considered.

Note, however, that secondary enuresis is only transient, and everything returns to normal quickly without any treatment.

From what age can we speak of secondary enuresis?

There is no real age to talk about secondary enuresis. It is simply necessary that these involuntary urination occur after a long period of cleanliness, without accident, of at least several months. On its site, the Health Insurance estimates that secondary enuresis usually occurs between 5 and 7 years. It further specifies that the percentage of children with nocturnal enuresis decreases with age: 49% of children between 3 and 4 years old, 11% of children between 5 and 7 years old, and 2 to 3% in adolescence.

Can adults also be affected?

It is quite possible for an adult to suffer from secondary enuresis, and to wet the bed after years, even decades without such incident. Especially since certain diseases or certain drug treatments have the effect of causing nocturnal enuresis. This is particularly the case with bipolar disorders, psychotic depression, Huntington’s disease, and neurodegenerative diseases in general. Certain cancers, in particular those of the bladder or prostate, can also cause urinary incontinence, and therefore secondary enuresis.

Is there a link between secondary enuresis and diabetes?

Bedwetting can be one of the symptoms of type 1 diabetes. Symptoms of this type of diabetes include: 

• an increased need to urinate, which becomes frequent and occurs day and night, with abundant urine (polyuria);
• increased thirst (polydipsia);
• weight loss despite an increased appetite;
• severe fatigue or blurred vision.

If one or more symptoms of this order are found in a child, it is better to discuss this track with a doctor in order to rule it out or not, so as not to risk missing out on this pathology.

Secondary enuresis: is it always diurnal or nocturnal?

Secondary enuresis is most often nocturnal, and occurs when the person is sleeping soundly. However, it happens that the secondary enuresis is also diurnal (during the day), and that the individual suffers from urinary incontinence. In this case, it is necessary to further explore the pathological track, because a secondary enuresis which would be at the same time diurnal and nocturnal can conceal diabetes, a urinary infection (or cystitis), or even a kidney problem. 

Child psychology: one of the main causes of secondary enuresis?

Secondary enuresis is most often explained by one or more events that have caused emotional stress in the child. Enuresis is then the sign of a regressive passage or depressed state, linked to a “traumatic” or at least annoying event: the birth of a new child, a move, the death or departure of a loved one, a serious illness in a loved one, a failure at school… Although enuresis secondary often heals spontaneously, do not hesitate to consult if it persists. Because these “bedwetting” problems have important repercussions on the child’s life, with a low self-esteem, and on his social and family life, with ultimately behavioral disorders in the child. It is therefore better to intervene before this secondary enuresis does more damage.