Night bedwetting is a health problem experienced by millions of children around the world. If a child over the age of 5-6 has urinary incontinence during the night, this is called bedwetting (enuresis nocturna). Before this age, it is not considered abnormal for children to wet the bed at night.
Children's daytime retention usually occurs by age 4, but nighttime retention typically takes longer and urine retention is not expected until they are 5-6 years old. At age 4, approximately 1 in 3 children wet the bed, but this drops to approximately 1 in 10 by age 6. The reason for this is that neurological maturity in children is completed at this age. Approximately 15% of five-year-old children have bedwetting at night. It decreases by approximately 15% each year, falling to approximately 1% by the age of 15.
In general, bedwetting at night is considered a part of the child's growth and development. Therefore, it is not a cause for concern if children wet the bed before the age of 6, as the child is still in the period of developing bladder control at this age.
When to see a doctor?
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If bedwetting is accompanied by burning sensation in urine, pain, bleeding (pink or red urine), unusual thirst, constipation or snoring during sleep.
If fecal incontinence occurs along with urine
If daytime incontinence occurs along with night wetting
In the light of this information, children who wet the bed at night can be grouped as follows:
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Those who only wet the bed at night Children: If there are no other accompanying conditions and only urinary incontinence at night, this is called pure-enuresis nocturna.
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Children with complex night-wetting: Night-wetting. accompanying wetting; daytime urinary incontinence, sudden urge to go to the toilet/leaking urine before reaching the toilet, intermittent interruption If there are some complaints such as urination, straining while urinating, fecal incontinence and constant constipation, this is called complex night wetting (enuresis nocturna), which is not isolated.
Children who wet the bed can also be grouped as follows:
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Primary bedwetting (primary enuresis nocturna): Primary enuresis means that the child has never gained nighttime urinary control,
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Secondary bedwetting (Secondary enuresis nocturna): Secondary enuresis means that the child has a dry period of at least 6 months after turning 5 years old, that is, the child incontinence again months and years after the child becomes dry. Since it is known that psychological factors may be at the forefront in such patients, this distinction must be made carefully.
What are the Causes of Wetting the Bed at Night?
The exact cause of bedwetting is unknown, but it is known that various reasons play a role in night wetting. These factors may be: The first three are considered the main factors of night wetting.
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Small capacity and overactive bladder: The child's bladder is at night. The capacity to retain and store the urine produced may not be developed and/or there may be inappropriate contractions in the bladder. In children with urinary incontinence, a decrease in the functional bladder capacity during sleep or excessive activity of the bladder at night is one of the main underlying factors in children who wet the bed.
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Not feeling that the bladder is full: Controlling the bladder. If the nerves involved are not fully mature or are slow to mature, a full bladder may not provide a warning sufficient to wake the child, which is especially important in children with deep sleep depth.
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Hormone imbalance: Normally, urine production at night is half less than during the day, and this is caused by a hormone called ADH (antidiuretic hormone) secreted at night from the base of the brain (pituitary). provided by hormone It is. Absence, insufficient or inappropriate secretion of this hormone results in urine production at night as well as during the day. This may cause them to urinate at night.
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Urinary tract infection:Urinary tract infections can make it difficult for the child to control his/her urine. In addition to night wetting in these patients; It may be accompanied by urinary incontinence during the daytime, frequent urination, bleeding in the urine, and burning sensation while urinating.
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Sleep apnea and respiratory tract obstructions: Inflamed and enlarged Obstructive sleep apnea (temporary respiratory cessation), which is a condition in which the child's breathing is interrupted during sleep due to respiratory problems such as tonsils, adenoids and nasal congestion, may be a reason for night wetting. Snoring may be observed in these patients, and fatigue and drowsiness may be observed during the day because the sleep quality is impaired.
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Diabetes: If the child, who was previously dry, begins to urinate at night. This may be the first sign of diabetes. Other complaints in children with diabetes include urinating in large amounts (in volume), feeling constantly thirsty - drinking a lot of water, and losing weight despite having a good appetite.
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Chronic constipation: The same muscles are used in urination/holding in and defecation/defecation. When there is long-term constipation, these muscles can become dysfunctional and contribute to bedwetting at night.
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Structural defects in the urinary tract or nervous system:In rare cases, the child It may cause night wetting problems due to defects in the neurological system or urinary system.
Risk Factors for Bedwetting at Night. What are they?
Risk factors of bedwetting are:
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Gender: It is twice as common in boys as in girls.
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Stress and anxiety: The arrival of a new child in the family. Stressful events, such as starting a new school or sleeping away from home, can trigger nighttime bedwetting. lir.
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Family history: It is a known fact that if one or both of the child's parents wet the bed as a child, it increases the likelihood that their child will also wet the bed. Bedwetting at night is known to have an underlying genetic basis, and several genes associated with this condition have been identified.
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Attention Deficit and Hyperactivity Disorder: Bedwetting is more common in children with Attention Deficit and/or Hyperactivity Disorder, the definitive diagnosis for bedwetting problem. It is considered a risk factor
The psychological and physical problems expected in a child who wets the bed Troubles include: Complications
Although annoying, bedwetting without a physical cause is unlikely to pose any health risks. However, some of the problems expected in a child who wets the bed are as follows:
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A child who wets the bed generally experiences a decrease in self-confidence and self-esteem due to guilt and shyness. Loss of self-confidence is evident and some personality disorders are observed. They do not take much responsibility.
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These children have socialization problems and cannot participate in social activities such as staying in a place as a boarding house and camping.
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The child may have urine-related skin rashes on his butt and genital area. Especially if the child sleeps in wet underwear and does not change it, such skin problems may occur.
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What is done in diagnosis?
In the child who wets the bed, A series of examinations and tests are performed to determine whether there is any underlying cause. These are:
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History and family history: A detailed questioning and history from the child's family and himself form the basis of the diagnosis. First of all, it should be clarified whether urinary incontinence only occurs at night or is accompanied by other problems such as urination problems / constipation. This Therefore, the family should pay attention to the child's condition during the day. Discussing the child's daily fluid intake, family history (whether other family members and parents have it), bowel and bladder habits, and problems with bedwetting
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Physical examination:General physical examination of the child may give a clue about a problem that may underlie bedwetting.
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Completing the bladder diary and symptom score form: Attention beforehand If not, filling out a voiding chart (bladder diary) and a voiding disorders symptom score form, which helps reveal the child's daily voiding habits, will provide valuable information on this subject.
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Laboratory tests:Urine, routine blood tests and kidney function tests; It can provide valuable information, especially regarding diabetes and urinary tract infections.
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Imaging tests:Ultrasound of the kidneys or bladder to look at the structure of the urinary tract, and more advanced tomography when necessary. and MRI may be required.
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Uroflowmetry and urodynamics: It is not among the routine tests, it can be done to detect some problematic and neurological problems. Uroflowmetry is a simple examination that measures urine flow rate electronically. In invasive urodynamic examination, the doctor or nurse inserts a catheter into the urinary tract and the anus (rectum) to measure intra-abdominal and bladder pressure. By slowly sending fluid through the inserted catheter, a situation similar to the filling of the urinary bladder is created, and all pressures are measured and recorded during filling and emptying.
What should be the treatment approach for a child who wets the bed
Most children grow up wetting the bed on their own. If the complaints in children at an early age are not at a level that impairs the quality of life of the child and his family, and the child is not very uncomfortable or embarrassed, treatment can be postponed for a while, assuming that this situation will go away as he grows up. Recommend to these kids again
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