Urinary incontinence is a common problem in children. About 15 percent of five-year-olds have trouble urinating. The majority of these children experience enuresis nocturna, or bedwetting at night. While the rate of urinary incontinence in 6-year-olds drops to 13%, this rate is 10% in 7-year-olds. As age increases, the incidence of urinary incontinence decreases. The rate drops to 1-2% in people aged 15 and over.
What is Enuresis?
Many people ask physicians what enuresis means, which is a common condition in our country. The word enuresis means bedwetting. Nocturnal incontinence is enuresis nocturna, and both night and daytime wetting is enuresis diurna. Enuresis is divided into two as monosymptomatic or non-monosymptomatic. Monosymptomatic enuresis is the absence of any symptoms in the lower urinary tract other than bedwetting or impaired bladder function. Monosymptomatic types of enuresis are divided into primary and secondary. Primary monosymptomatic enuresis is the more common type, and it is a constant bedwetting problem. Secondary is the onset of urinary incontinence after a period of at least six months without bedwetting. In case of non-monosymptomatic enuresis, the following symptoms may be observed in addition to bedwetting:
- Continuous increase (8 or more per day) or decrease (3 or less per day) in frequency of voiding
- Daytime urinary incontinence
- Sudden feeling of urgency
- Difficulty initiating voiding
- Using abdominal pressure to initiate or maintain voiding
- Weak urine flow
- Using to urinate intermittently, not all at once
- The feeling of incomplete emptying of the bladder
- Dripping after voiding
- Pain in the genital area or lower urinary tract
Why does Enuresis Occur?
Normally, the bladder functions in the brain stem, midbrain, brain z It is based on the complex relationship between the bee (cortex) and the autonomic and somatic nerves, in which part of the spinal cord is involved. While autonomic nerves control involuntary movements, somatic nerves enable the contraction and relaxation movements of voluntary muscles. This coordinated relationship within the nervous system plays an important role in keeping the urine in the bladder and when the pressure in the bladder increases, the muscles in the bladder wall (detrusor muscle) contract and the urine comes out. Since this coordination has not yet occurred during birth, when the bladder is full, contraction cannot be controlled and urination occurs uncontrollably. During the first three years of life, the capacity of the bladder increases disproportionately to body surface area. At the age of four, most children pee five to six times a day. The development of the bladder control mechanism happens over time. At first, children realize that the bladder is full, and then the ability to prevent contraction of the bladder wall muscle develops. As a result, the coordination between the sphincter muscles and the detrusor muscles, which prevent the urine from leaving the bladder, is learned. Daytime use of these abilities usually occurs at the age of four.
Nocturnal bladder control is usually learned months or years later and is not expected to occur until the age of five to seven years. The fact that this development process in the bladder is not completed immediately almost always causes bedwetting problems associated with urinary incontinence during the day. The reason for this is usually bladder dysfunction, overactive bladder, underactive bladder, recurrent urinary tract infections and in some cases vesicoureteral reflux (urine rising up from the bladder). may occur due to many reasons. It can occur in conditions related to nervous system development such as autism spectrum disorder and attention deficit hyperactivity disorder. In addition, psychological abnormalities are among the causes of non-organic enuresis. In other words, a definite relationship has not been found yet as to why psychological problems cause enuresis. Known organic causes of bedwetting are examined under two headings:
- Renal/Urological Causes: Bladder dysfunction, urinary tract infection, chronic kidney disease, ectopic ureter (kidney bladder) in women Upper urinary tract that connects it to a place other than the upper urinary tract)
- Other Underlying Medical Conditions: Constipation, sickle cell disease, seizures, diabetes, diabetes insipidus, obstructive sleep apnea, pinworm, primary polydipsia (voluntary excess water drinking)
Enuresis Treatment
Initial treatment of enuresis consists of correcting the accompanying conditions, setting goals and expectations, providing advice and education, and motivation therapy.
- Correction of concomitant conditions: Enuresis treatment should be started at the same time. Concomitant conditions may affect the course of the problem and the response to treatment. Therefore, the underlying factors should be determined in patients with secondary enuresis. Conditions such as constipation, sleep apnea (snoring), attention deficit hyperactivity disorder should be treated.
- Setting goals and expectations: No wetting problem in special situations such as going to sleep, reducing the number of bedwetting at night Goals such as avoidance of repetition should be set. In addition, it is necessary to reduce the effect of the problem of bedwetting on the family and the child.
- Giving advice and education: The questions that remain in mind before and after the treatment should be asked to the physician. Compliance with the advice and training given to patients and their families during the treatment process has an important effect on the treatment process.
- Motivation therapy: It is necessary to provide the necessary motivation to follow up the bedwetting during the treatment process. Ensuring motivation is an effective method in the beginning, especially in children between the ages of five and seven who do not have bedwetting problems every night. In the studies, it has been seen that the application of a reward system such as giving stickers to provide motivation, collecting stickers and giving certain rewards contributes positively to the treatment. starts playing. In this way, the problem of bedwetting can be treated with the development of the conditioning reflex. The drug called desmopressin, which is used in the treatment of enuresis, plays an active role in the treatment by reducing the amount of urine. This medicine, which is in pill or nasal spray form, is used at night before going to bed. It also dissolves under the tongue. Desmopressin is also effective in the treatment.
How to Prevent Incontinence?
Early diagnosis is very important in order to prevent enuresis. In patients with early diagnosis, treatment is started quickly and positive results are obtained in the problem of bedwetting. In addition, a supportive approach is necessary, as bedwetting causes self-confidence problems, especially in children. It is important for children to learn that this problem is a common condition and to know that the problem can be overcome. In addition to emotional support, taking some precautions is effective in preventing the problem of bedwetting in children:
- Limiting fluid intake in the evening: It is necessary not to give caffeine-containing drinks such as tea and carbonated drinks, especially in the two hours before bedtime.
- Children should be given the habit of going to the toilet before going to bed.
- Children should be encouraged to use the toilet at night instead of focusing on not wetting the bed at night. In this way, the habit of going to the toilet every night should be gained.
- Children should have easy access to the toilet. It is important that night lights are placed between the bed and the toilet and that there are no obstacles in the way of the toilet. If necessary, portable toilet should be used.
- Although the use of absorbent diapers at night is recommended by some doctors, it is sometimes not recommended. Therefore, it can be decided to use it in consultation with the physician.
- The bowel movements of children should also be observed. In case of constipation, it may be difficult to empty the bladder effectively and completely. Therefore, it is absolutely necessary to consult a physician in case of constipation.
It is possible to get more effective results when bedwetting (enuresis) treatment is started early. People who want to learn more about enuresis and its treatment should apply to health institutions. We wish you healthy days.
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