BED WETTING (ENURESIS NOCTURNA)
If a child is older than five years-old, and continues to have urinary incontinence at night, this is called bedwetting (enuresis nocturna). It is not considered abnormal for children to wet their beds at night before the age of five. Bed wetting problem is more common in boys and its incidence decreases with age. Approximately 15% of five-year-olds have a problem of bed wetting at night. Its incidence decreases by 15% each year and decreases to approximately 1% during adolescence. This information makes us think that bd wetting is due to the delay in the normal development process of the child.
CAUSES OF BED WETTING
There is a large genetic predisposition at the root of this problem. If the mother or father has a history of bedwetting, 44% of the child has a bedwetting problem, and 77% of them have this problem in both parents have a history of bed wetting.
Increased urine production at night: If there is a problem in the rhythm of the release of the ADH hormone, which is released at night and reduces urine production by keeping water in the body, night urine production increases and urine incontinence results.
Deep sleep and waking up problems: These children have a problem of perceiving bladder fullness or not being able to wake up even though it is perceived.
Involuntary contractions of the bladder: This condition, which usually causes daytime voiding symptoms, can also lead to urinary incontinence at night.
Psychological reasons: It is determined that 5-10% of children with urinary incontinence have underlying psychological reasons.
Organic problems: There are problems such as urinary infection, hyperthyroidism, diabetes mellitus, voiding dysfunction, urethral valve, and sleep apnea in a small portion of the cases, such as 2-3%.
Sometimes children who do not have urinary incontinence problem may experience urinary incontinence problem that develops later due to psychological reasons such as being siblings, divorce of parents, loss of family members or maltreatment.
BED WETTING TREATMENT
Behavioral Therapy: Explaining the problem to the child and family and providing detailed information are very important in the success of the treatment.
Fluid intake of children should be restricted 2 hours before going to bed at night. It should be lifted and urinated before and 1-2 hours after sleeping. Consumption of salty foods should be avoided at dinner. Fluid intake should be evenly distributed throughout the day. If there is a constipation problem, it must be resolved. For this, fiber-rich foods and adequate fluid intake are essential.
Regulation of urination is also very important. The child should be able to go to the toilet every 2-3 hours at home and school and urinate regularly. In order for the pelvic floor muscles to relax and the bladder and intestines to fully empty, the child should sit in the appropriate position on the toilet, his feet should be on the ground, and if necessary, support should be placed under his feet.
The child should be asked to note wet and dry nights. A rewarding system to be applied here will motivate the child. However, punishment should be avoided.
Medication: The most commonly used treatment is the administration of hormone analogs (desmopressin) that reduce the amount of urine at night. The aim here is to increase the body’s water retention and decrease urine output by replacing the missing ADH / desmopressin hormone.
The biggest advantage of this treatment is that its effectiveness starts from the first dose and its use is easy. The most important disadvantage is that bed wetting can start again after the medication therapy is ended. Although there is a false belief among the public that medication causes infertility. The medication does not have such an effect, as reported in the literature.
Apart from this, there are some medication that regulates the problem of waking up at night or prevent the overactive functioning of the bladder at night depending on the underlying disorder.
Alarm Treatment: It is a treatment method recommended especially for children who have difficulty waking up. The main purpose here is to create a conditioned reflex in the child. The child awakened by the alarm that rings even when a drop of urine is incontinent, involuntarily contracts the bladder sphincter muscle and holds urine. The aim is to ensure that when the bladder is full over time, it is learned to wake up without urinary incontinence. This is a long-term treatment and every time the alarm goes off, the child must be taken to the toilet. It should be applied for at least 6-8 weeks to evaluate its effectiveness, and if there is a response to the treatment, it should be continued for 3-6 months.
DAY-TIME URINE INCONTINENCE AND URINATION DISORDERS
In about 20% of children over the age of five, urination disorders such as day or night incontinence, frequent urination, sudden urgency, urinary retention, difficulty in starting urine are observed. These problems are often caused by the inadequate bladder development while the child is growing. But first of all, neurological (neural) and anatomical (structural) reasons that may cause this situation should be ruled out. Because, if urination problems are not treated, neurological or anatomical serious disorders that can lead to kidney failure may occur.
First of all, a detailed anamnesis and examination and a few simple tests are performed to understand the origin of the child’s urination problems and whether there is an underlying disorder. By keeping a urination diary for a certain period of time, the seriousness of the problem is tried to be understood.
The child and the family are technically taught how to pee regularly and correctly, proper urination posture, avoiding urine retention maneuvers, prevention of constipation, control of fluid intake and regulation of lifestyle.
In addition to potty training in children, urinary incontinence can be treated with medication, training of pelvic floor muscles, biofeedback method (playing games) or interventional (surgical) methods, depending on the severity and type of urination problem.
Solution by Biofeedbak Method (Playing Games)
The “Urotherapy Method”, which aims to teach children to use urinary retention muscles, is defined as a bladder training and rehabilitation program that aims to correct filling and emptying disorders of the bladder.
After the urination suggestions, a 6-week practical training program is given to teach how to use the pelvic floor muscles in company with some computer-assisted games. Various computer animations are used in this treatment method, which we call “biofeedback”, which is applied once a week and lasts about 30 minutes each session.
With this fun program and short exercises to do at home, it is aimed to teach the child to control his urinary retention muscles himself.
In this program, the child is asked to move the fish or bird he sees on the computer screen and try to avoid the dangers (wolf, snake, etc.) he encounters. In order to do this, the child must tighten or relax the urinary retention muscles sufficiently. With this fun program and short exercises to do at home, it is aimed to teach the child to control his urinary retention muscles himself.
This treatment program, which has been applied for years in Europe and America, has started to be applied and gaining popularity in our country in recent years. In scientific studies conducted on the results of this treatment program, a success rate of over 90% is reported at the end of the 6-week treatment process without the need for medication.
NOTE: The page content is for informational purposes only, please consult your doctor for diagnosis and treatment.