Urinary incontinence is the involuntary urination at an inappropriate or socially unacceptable place and time. Urinary incontinence may occur during sleep (night incontinence, enuresis) or while awake (daytime incontinence).
Mostly boys
- Approximately 15-20% of 5-year-old children
- Approximately 7-year-old children 5-10%
- Approximately 1-2% of 15-year-old children pee in their sleep.
- Sleep urination is seen in 0.5-1% of adults.
If a child over the age of five urinates during sleep more than twice a month, it is considered abnormal. Urinary incontinence is an important condition that affects the child's self-confidence and social development and must be treated in a timely manner.
Urinary incontinence during sleep is actually a symptom, not a disease. There may be one or more etiological factors that may cause this symptom.
What are the causes of Urinary Incontinence during Sleep (Night Incontinence, Enuresis)?
1. Delay in the development of systems related to urination retention and production
2. Problems in acquiring toilet habits: If toilet habits are not established at the age when bladder control begins to be acquired, enuresis can be seen in large numbers in these children
3. Hormonal disorder:It is a situation where insufficient release of Antidiuretic Hormone (ADH)while asleep causes urine production exceeding the bladder capacity, causing enuresis.
4. Sleep disorders: Families of many children with urinary incontinence during sleep state that the child is a very heavy sleeper and has difficulty waking up. However, studies and clinical observations show that sleep-related problems alone are not sufficient to explain urinary incontinence during sleep.
5. Psychological factors: Psychological or psychiatric disorders are very often blamed as causes of urinary incontinence during sleep, and it is claimed that children with urinary incontinence have social adaptation problems and behavioral disorders. However, urinary incontinence The rate of patients with actual psychiatric illness or behavioral disorder in the current pediatric population is very low, and no specific psychiatric illness or behavioral disorder thought to accompany enuresis has been reported. Again, some studies conducted in recent years have shown that psychological disorders do not cause enuresis, but enuresis causes some behavioral disorders. The observation of positive psychological changes in children whose enuresis was treated supports the view that enuresis causes psychopathology, rather than psychopathology causing enuresis.
6. Urinary tract infections
7. Congenital abnormalities in the urinary tract: These children usually leak urine both while asleep and awake.
8. Genetic factors:Studies that enuresis is a genetic condition and chromosome research on enuresis continue.
What is done in the evaluation of a child suffering from urinary incontinence?
What is done in the evaluation? The most important purpose is to understand whether there is a congenital abnormality in the urinary tract.
Urinary incontinence history: A detailed and good history taken from the family of the child suffering from urinary incontinence prevents many unnecessary examinations. For this reason, the age of onset of enuresis, its frequency, presence of enuresis in the family, daytime urination/incontinence and number, daily fluid intake, constipation and fecal incontinence are questioned in detail. The family is asked to fill out a two-day voiding chart showing the child's voiding status and fluid intake, as well as defecation and incontinence.
Physical examination:In addition to a general examination, a complete neurological and urogenital examination is performed.
Full urine analysis and urine culture
As a result of these evaluations, if the child only urinates during sleep, if the examination findings are normal and the urinalysis is normal, then a diagnosis of monosymptomatic enuresis is made and no additional examination is required.
Single Finding Enu How Is Resis Treated?
First of all, the family and the child must be convinced that enuresis is a treatable condition. In the beginning, it is generally recommended for all children to have a healthy diet, a diet to prevent constipation, to encourage fluid intake during the day but stay away from caffeinated drinks, to urinate 5-7 times at regular intervals during the day, to avoid consuming liquid food after dinner, and to urinate before going to bed. If the child has constipation along with urinary incontinence, the constipation must be treated first. In the treatment of enuresis, the child, family and physician should work in harmony and patiently. The child and family are discussed in detail and patiently about the evaluation results and possible treatment methods, and the most appropriate and beneficial treatment option is determined. There are two types of treatment methods for single-sign enuresis:
1. Behavior Modification
2. Drug Treatment
Behavior Modification
Behavior modification methods are methods that give more successful results and have lower recurrence rates. However, this method requires good communication and patience between the doctor, family and child.
1. Motivation Therapy:The aim is to develop a good relationship between the child and the parents. By applying the calendar method, the child is rewarded on the days when he does not wet the bed. It is important that wet nights are not punished. This alone is often not enough. The chance of success is around 25%.
2. Conditioning-Alarm Treatment:The alarm device is a system that is placed in the child's underwear and gives an audible warning when the child starts to urinate. It is difficult to apply in children younger than 7 years old. After 4-6 months of treatment, there is a chance of success between 65-85%. However, there is a risk of recurrence after treatment is stopped.
3. Bladder Training:This type of treatment can be applied to some patients with enuresis because their bladder capacity is lower than normal. It is not a very useful method in practice.
What is Nonmonosymptomatic Enuresis?
If there is bacterial growth in the child's urine culture examination, If a history or presence of urinary tract infection is detected, if abnormal findings are detected in the nervous system examination, if there is urination during sleep along with urinary incontinence or incontinence while awake, then we can talk about enuresis, which is not a single symptom. In this case, in addition to the initial tests:
Ultrasonography: The presence of abnormal development in the kidneys and urinary tract is investigated and the amount of urine remaining in the bladder after urination is measured.
Urinary flow measurement (Uroflowmeter): It is performed to detect the presence of a congenital or acquired disorder in the lower urinary tract that prevents urine flow.
X-ray examination: It is investigated whether there is a congenital abnormality in the spine.
Voiding cystourethrography: An abnormality in the bladder and It is investigated whether there is urine leakage into the kidneys (vesicoureteral reflux).
Magnetic Resonance Imaging (MR): If abnormal findings are detected in the examination of the nervous system, it is a congenital abnormality. It is done to determine whether the
Urodynamics: The coordination between the urinary bladder and the urinary tract and the conditions of the urinary bladder at the time of filling and emptying are evaluated.
How is Nonmonosymptomatic Enuresis Treated?
Treatment is applied for the identified cause.
Conclusion
Timely and appropriate treatment of children with urinary incontinence is very important and neglected on their social lives, self-confidence and future lives. This is a situation that should not be done.
We wish you healthy and happy days,
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