Primary enuresis 

Primary enuresis means a child has never been dry, and has wet the bed ever since he or she was a baby. This is the most common type of bedwetting in children.

Over 75% of children affected by bedwetting have primary enuresis and is more common in boys than girls.

So in regards to what treatment pathway you should go down if your child has never been dry before, depends also on whether they have ‘one symptom’ wetting or experience other bladder or lower urinary tract symptoms. 

For example, a child who has never been dry before and wetting while sleeping is the ONLY problem, then they should respond well to first line treatments, such as a bedwetting alarm or medication.

But if a child who has never been dry before and suffers from other bladder symptoms, then it’s important to treat any daytime wetting or the other bladder problems first, before undertaking first line treatment such as an alarm. 

So to recap, primary enuresis is when a child has never been dry, and this is the most common type of bedwetting in children.

Secondary enuresis

Secondary enuresis means a child has previously been dry for 6 months or more but then starts wetting. Secondary enuresis accounts for about 25% of children with bedwetting.

When a child begins wetting the bed after they have learned to control their bladder at night, it can have a significant impact on their emotional wellbeing. It can bring on feelings of embarrassment, anxiety and loss of confidence. It can also affect their quality of life and performance at school.

Doctors don’t alway know the exact cause of secondary enuresis. But here are some likely causes and contributing factors:

• Sleep problems
• Obstructive sleep apnea
• Bladder problems
• Overactive bladder
• Medical conditions
• Psychological stress
• Hormone problems
• Genetics

Unlike primary enuresis, in which the underlying causes are mostly developmental, the onset of secondary enuresis can be a sign of an underlying medical condition. Or caused by stress or an emotional upset. 

It is important for a doctor to carefully identify which group a child fits into because this may affect how well the child should respond to first line treatment, such as a bedwetting alarm.  

I’ll give you an example. A child with secondary enuresis and experiences other bladder symptoms in addition to wetting the bed at night, then the child is less likely to respond to first line treatment such as a bedwetting alarm. They’ll also be more complicated to manage and may take longer for the child to achieve dryness.

If your child starts wetting again after being dry for 6 months or more, the first step is to visit their doctor to assess whether they have any underlying medical causes. Then approach it with a positive attitude and keep their motivation up. It’s important to instill confidence in your child and remain optimistic around them. 

Make sure they are visiting the toilet regularly during the day and keeping up their fluid intake throughout the day and early evening. Remind them to visit the toilet right before going to bed and make sure they are completely emptying their bladder when they go to the toilet.

Please check out the download I’ve included below this article which will help you to understand the different types of bedwetting and how they can be further broken down in their classifications.