In a child with waking problems, it occurs as a result of the imbalance between urine production and bladder capacity during sleep. Generally, in school-age children, it is normal physiological urination at an undesirable (inappropriate) place and time. It is not normal for a 5-year-old child to wet the bed more than two nights a month. This is when the child wets the bed involuntarily and unknowingly while sleeping. These children empty their bladder completely, but without realizing it.
What is its frequency? If the parents have it, the child can also have it. Urinary control is achieved in 90% of children over the age of 5. Of the remaining 10%, 15% gain urinary control each year. "Enuresis" continues after puberty in 1-3% of cases. 1% of 18-year-olds wet their bed while sleeping. If both parents have this problem, it is seen in 75% of children. If the mother or father has experienced this problem, the risk of occurrence in children is 40-45%. It is twice as common in boys.
What are the risk factors? Factors such as genetic family history, physical and mental developmental delay, low education and socio-cultural level, large and poor families, child abuse, sleep problems, constipation, upper respiratory tract obstruction may play a role.
What are the causes? ? The reason is organic, not psychological. If left untreated, their psychology deteriorates.
• Not perceiving the sensation of urination during sleep
• More urine production than normal at night
• Incomplete maturation of the central nervous system
• Incomplete development of bladder and sphincter muscles
• Insufficient secretion of substances that reduce urine production (ADH-desmopressin).
Since most of these children produce more urine than normal at night or have small bladders, they are heavy sleepers. During sleep, the fullness of the bladder (urinary bladder), that is, the need to urinate, is not felt and the child who is stuck in urine urinates reflexively without waking up. Disorders related to bladder function are detected in some of these children.
How does it affect children?
It causes a feeling of shame and inferiority complex
If left untreated, it may cause psychological problems in the patient and their family over time. In other words, psychological problems are not the cause of the disease, but the result.
A person who is reacted by his/her environment due to bed-wetting is a person who needs to look elsewhere. The child who cannot stay overnight, cannot go on vacation and is ashamed of his situation is psychologically affected.
As a result of chronic stress; Decrease in self-confidence, introversion, feeling of shame, inferiority complex, depression and behavioral disorders are observed.
What perspective does society have?
Are the Child and the Family Guilty? Bedwetting is not a conscious behavior of the child. It is a disorder that the child cannot control. It doesn't mean that their parents didn't educate them well. This problem is related to the delay in the maturation of the organs that control urine during the child's growth.
Punishment does not solve the problem. Attributing it to the child's laziness and applying punishment and beating does not solve the problem. Children are not clearly at fault for this disease, which develops due to completely concrete organic reasons. For this reason, instead of punishment, families should see these children who are victims of the disease to a doctor as soon as possible.
How is the diagnosis made?
Detailed questioning and meticulous examination are very important. Bladder ultrasound and voiding test can provide useful information.
How is it treated?
Bedwetting problem may resolve itself over the years; 15% of these children may recover spontaneously each year. However, it is necessary to ignore this easily treatable condition and wait for it to go away on its own after the age of 5-6, as it causes significant psychological problems in the child.
Behavioral treatment (Support and motivation treatment) Supportive treatment and rewarding in these children. should be a priority. Family and child should be informed and motivated together. It should be explained that sufficient time and patience is required. A warm relationship should be established with the child and confidence should be given that the problem will be solved. It should not be compared with other children, the feeling of guilt should be eliminated and the child's self-confidence should be renewed.
Alarm treatment An electrode placed in the underwear causes the device to ring a bell when wetting the bed during sleep. In this way, it is aimed for the child to perceive the feeling of urination during sleep over time. Results are usually seen within 3 months.
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