- URINARY INCONTINENCE IN CHILDREN
What is urinary incontinence?
Urinary incontinence (enuresis)is the condition of involuntary urination at an inappropriate or socially unacceptable place and time. Urinary incontinence may occur while asleep or awake. Mostly boys
- About 15-20% of 5-year-old children
- About 5-10% of 7-year-old children
- Approximately 1-2% of 15-year-old children urinate in their sleep.
- Enuresis is also seen in 0.5-1% of adults.
Any person over the age of five It is considered abnormal if the child urinates during sleep more than twice in a month.
Primary enuresis: Vorination during sleep has been present since birth, that is, there has never been a long period in the child's life when he/she got out of bed dry.
>Secondary enuresis: Complaints of enuresis began after a dry period lasting at least six months. Secondary enuresis is observed in approximately 20-25% of all children with enuresis.
Familial tendency: In the families of children who urinate in their sleep, a history of enuresis in childhood is quite common in the mother and/or father. Familial history is also high for children with enuresis in our country
What are the causes of urinary incontinence?
Enuresis is actually a symptom, not a disease. There may be one or more etiological factors that may cause this symptom.
Delay in the development of systems related to urination and urine retention
Poor toilet habit. Problems in acquiring: If toilet habits are not established at the age when bladder control begins to be acquired, these children have a high rate of Enuresis can be seen in children
Hormonal disorders
Sleep disorders: Families of many children with enuresis state that the child's sleep is very heavy and it is difficult to wake up. . However, studies and clinical observations show that sleep-related problems alone are not sufficient to explain enuresis.
Psychological factors: Psychological or psychiatric disorders are frequently blamed for the etiology of enuresis, and it is claimed that children with enuresis have social adaptation problems and behavioral disorders. However, the rate of patients with actual psychiatric disease or behavioral disorder in the population of children with enuresis is very low, and no specific psychiatric disease 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.
- Urinary tract infections
Congenital abnormalities in the urinary tract
What is done in the evaluation of a child with complaints of urinary incontinence?
Patients with enuresis are generally healthy children and do not have any other pathologies. The most important purpose of the evaluation to be performed on the first patient presenting with enuresis is to understand whether there is an anatomical urinary system pathology.
Urinary incontinence history: A detailed and good history taken from the patient with enuresis prevents many unnecessary examinations. . Patients should be asked to complete a voiding chart.
Physical Examination: In addition to a general examination, a complete neurological and genital examination should be 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 urine test is normal, then a diagnosis of uncomplicated enuresis is made and no additional examination is required.
How is uncomplicated enuresis treated?
There are different treatment methods. At the beginning, it is necessary to talk in detail and patiently with the child and family about the evaluation results and the treatment methods that can be applied and to determine the most appropriate and beneficial treatment option. There are two types of treatment methods for uncomplicated enuresis:
- Behavior Modification
Pharmacological Treatment
There is no scientific evidence that methods other than these, such as restricting fluid intake, frequent urination, punishment, or hypnosis, are successful.
- Behavior Modification
- Medication treatment:
- Examination of the kidneys and urinary tract by ultrasonography
- Measurement of the amount of urine remaining in the bladder after urination
- How is complicated enuresis treated? vi?
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.
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. This alone is often not enough. The chance of success is around 25%.
Condition-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. 65-85% after 4-6 months of treatment There is a chance of success. However, there is a risk of relapse after treatment is stopped.
Bladder retention Training: This type of treatment can be applied to some patients with enuresis because their bladder capacity is lower than normal. In this treatment, the child is made to drink excessive fluid throughout the day and is asked to hold urine for a long time. It is not a very useful method in practice.
It is a treatment method that is easy to apply and gives results in a short time, but it does not cause recurrence. The rate is high.
What is complicated enuresis?
If the patient has bacterial growth in the urine culture examination, if a history or presence of urinary tract infection is detected, the nervous system examination If abnormal findings are detected, if urinary incontinence or urination is present while awake, then we can talk about complicated enuresis.
If the patient is considered to have complicated enuresis, in addition to the initial tests:
X-ray examination: It is performed to determine whether there is a congenital abnormality in the spine.
Voiding cystourethrography (Voiding Cystourethrography): It is performed to determine whether there is an abnormality in the bladder and urine leakage to the kidneys
MRI: If abnormal findings are detected during the examination of the nervous system, it is performed to determine whether there is a congenital abnormality.
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.
Treatment is applied for the identified cause.
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