If there is bedwetting that continues after the age of 5, this problem may be mentioned. Its general frequency in society is quite high. While it is seen in 15% of 5-year-old children, this rate decreases to 5% by the age of 10.
- Causing factors:
Genetic factors and delayed development in the nervous system: The most frequently accused reason is the delay in the central nervous system, which also controls the urinary bladder. In these children, unnecessary contractions of the bladder cannot be suppressed, and the functional capacity of the bladder is also lower. It is thought that this delay is due to genetic factors and that is why the bedwetting problem is more common in the same family. When one of the parents wets the bed at night, the probability of its occurrence in their children is between 50% and 75%.
Increased urination at night: Some of the studies show that children who wet the bed at night urinate more at night than those who do not.
Hormone deficiency (ADH deficiency), which reduces urine production:Some studies show that this hormone, which should increase at night, is released insufficiently in children who wet the bed at night, or that this hormone is counteracted. It has been shown that the kidneys do not respond well.
Sleep problems: It is known that the depth of sleep is generally greater in children with enuresis.
Psychological factors. :Although rare, psychological trauma can cause bedwetting at night. It is a condition that is usually encountered in bedwetting at night (secondary enuresis), which begins after being dry for a long period of time (6 months and above).
- Evaluating a Child with Enuresis
The main purpose of the evaluation is to understand whether there are any underlying diseases that may cause nighttime urinary incontinence, apart from the factors listed above.
For this purpose. Incontinence during the day as well as at night, difficulty urinating, accompanied by fecal incontinence or constipation, drinking plenty of water with dry mouth, presence of snoring and apnea attacks during sleep, attention deficit and hyperactivity, history of previous urinary tract infection, presence of parasites in the stool, etc. � Breast-running defects, mode of birth, and the presence of an opening or skin abnormality on the spine at birth should be questioned.
In addition, a urination diary should be kept in which urination and incontinence during the day and at night are noted, and a complete physical examination should be performed.
In children who are thought to have no other underlying disease, only a urinalysis is sufficient as a test. Otherwise, additional relevant tests and different radiological imaging may be needed.
Treatment
If there is another underlying and accompanying disease, these should be treated first.
If the only complaint is bedwetting at night and there is no other accompanying problem, it should be known that this condition is easily treatable.
The first thing to do is behavioral treatment and correction of habits. These can be summarized as urinating at regular intervals during the day, restricting water, liquids and diuretic sugary foods in the evening, going to the toilet before going to bed, and waking up at night to go to the toilet. Meanwhile, the family must have a supportive attitude towards the child, not a punitive one. In addition, diapers, if used, should be abandoned. In cases of incontinence that does not improve in this way and occurs frequently, or in incontinence that causes social problems and loss of self-confidence for the child, even if incontinence occurs rarely, drug treatment and alarm applications are used. The first option in drug treatment is the external administration of an artificial substance that acts on the natural body hormone (ADH), which reduces urine output from the kidney. This medicine is used as a tablet that dissolves under the tongue or as a spray applied to the nose. In some cases, a bladder relaxant medication may be added. Early and successful results are usually achieved with drug treatment, but there is a high probability of recurrence when drug treatment is stopped suddenly. Therefore, the drug dose must be reduced and discontinued. Alarm treatment is generally suitable for children over the age of 7 who can adapt to the alarm system. An alarm that is attached to the laundry or sheets and sounds when it detects wetness is aimed at helping the child with a full bladder get used to holding urine over time. medicine to get answers Its disadvantages are that it takes longer than treatment and the family cannot get used to the alarm sound. However, after success is achieved with this form of treatment, relapse is less likely than with drug treatment.
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