Urinary Incontinence Problem in Children
Bedwetting at inappropriate times in childhood is a common condition and constitutes 40% of the cases coming to the pediatric urology outpatient clinic. This condition can manifest itself as urinary incontinence only at night or urinary incontinence both day and night.
Normally, children achieve nighttime urinary control at the age of 4, and daytime control is achieved earlier. As studies conducted in our country and abroad show, 15% of 5-year-old children and 1% of 15-year-old children have urinary incontinence at night. Although 15% of children with nocturnal urinary incontinence recover spontaneously without any treatment each year, the most important indicator of the need for treatment is that the bedwetting problem causes social and psychological problems for both the child and the family during this period.
Primary Enuresis Nocturna:
It is the condition of wetting the bed only at night without any complaints during the day.
The reason for this is multifactorial and includes a positive family history, low functional bladder capacity, ADHdeficiency and night waking problems are the main ones.
Day-Night Bed Wetting:
a. Dysfunctional Voiding:It is a problem that manifests itself as intermittent urination and inability to fully empty the bladder after urination, resulting from the child urinating by contracting the sphincter and pelvic floor muscles that hold urine at the base of the bladder during the bladder emptying phase as a result of incorrect urination training, and the deterioration in bladder dynamics caused by this. . Constipation is also a common condition in these cases.
b. Urge Syndrome:It is a condition in which urinary incontinence occurs due to involuntary contraction of the bladder during the bladder filling phase, before the amount of urine in the bladder reaches its capacity, and the pressure increase resulting from these contractions.
c. Underactive Bladder:It is the least common condition in this group and is manifested by the bladder not being able to contract sufficiently and emptying the urine and urine remaining in the bladder after urination.
Urinary Incontinence While Laughing:< br /> Although it is mostly seen in teenage girls, it can also occur in boys. It is a condition in which urinary control is lost during very intense laughter. It is defined as a developmental problem and is caused by the close proximity of the laughing and bladder control centers in the brain. It is a disease that resolves spontaneously over time and in some cases drug therapy may be added.
Treatment
The success of the treatment depends on correctly diagnosing the child according to the classification above and planning the treatment accordingly. Treatment alternatives according to classification are as follows.
Primary Enuresis Nocturna
Restriction of liquid drinks and foods taken before bedtime: Reducing fluid intake in the 1-2 hour period close to bedtime and sugary, It is a method based on avoiding caffeinated drinks as they are thought to increase bladder contractions.
Waking the child up at certain times to urinate at night: This method, which most families apply before consulting a doctor, is not very useful in the long term, but can be applied with fluid restriction as a part of the treatment.
/> Alarm devices:It is based on the principle that the child wakes up with the help of an alarm that warns when urine touches the device during sleep and then goes to the toilet to urinate, and it is a very successful method in the long term. It is a disadvantage that it requires constant parental supervision.
Dysfunctional Urination:
Voiding Therapy:
Toilet habits and problems in children with urinary incontinence. It is a form of treatment that aims to correct the diet, if necessary.
Biofeedback Therapy:
It is a treatment method that aims to teach the patient normal physiological body activities, which he does not normally know, using computers and similar devices. With this method, it is aimed to correct the wrong behaviors that the patient has been doing for many years, which is the reason for urinary incontinence and disrupts the bladder dynamics, and to prevent urinary incontinence.
In the child age group, especially in cases where the sphincter, which must contract and subsequently relax the bladder to urinate, cannot be relaxed, 4-6 months of age. It ensures that completely normal physiology is learned after the session. Biofeedback is used in selected cases to prevent other complications of urination dysfunction from difficult situations such as surgery. It allows correction without any delay.
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