Sleep Urination

Sleep urination, also known as "enuresis nocturna", is defined as involuntary urination during sleep, occurring at least twice a week for 3 consecutive months after the age of 5, and without the effect of any underlying disease or medication. Wet sheets and pajamas and an embarrassed child are a familiar scene in many homes. However, you should not despair, because urination during sleep does not indicate that toilet training is going bad and is a normal part of child development. It is caused by the incompatibility between the functional capacity of the bladder and the amount of urine produced during sleep.

During their normal development, children generally begin to gain bladder control between the ages of 2-3. Bladder capacity, which is approximately 15-20 ml at birth, increases with age and reaches 500-700 ml in adulthood. During the neonatal period, the bladder empties reflexively on average 15-20 times a day. After the sixth month, bladder capacity increases and urination frequency decreases. Voluntary urination begins in children around the age of one or two. Night control is completed between the third and fourth years.

Expressions such as bedwetting or wetting the bed during sleep should not be used as they are accusatory definitions, and the term "sleep urination" should be preferred instead.

Primary. There are two types of sleep urination: secondary and secondary. Primary type sleep urination continues since birth with no dry periods in between. In the secondary type, toilet training is provided for at least 6 months, but then sleep urination begins again.

When should it be considered a problem and a doctor should be consulted?

Sleep peeing is not a serious problem under the age of seven. Most children complete toilet training around the age of five, but there is no specific age for full bladder control to be achieved. Sleep urination continues to decrease between the ages of 5-7 and remains a problem in very few children at the age of 7. It is seen in 5-10% of children around the age of seven and resolves spontaneously at a rate of 15% per year. However, in 7% of these children, the problem continues until adulthood.

Sleep urination disappears on its own in most children, but some children may require intervention. In some cases, it may be a sign of other underlying problems and should be investigated. It should be removed.

• If it persists until the age of seven

• If it recurs a few months after complete dryness is achieved at night

• If accompanied by pain or burning when urinating, pink or red urine, unusual need to drink water, constipation and snoring

What are the causes?

Although the exact cause is not known, various factors may play a role.

• Small bladder: The child's bladder is sufficient to store urine at night. It may not be as developed.

• Inability to sense bladder fullness: If the development of the nerves that control the bladder is slow, waking problems may occur, especially when the child is in a deep sleep.

• Hormonal imbalance: In some children, hormones that reduce the amount of urine produced at night may not be produced yet.

• Stress: A new school, in the presence of a new sibling or in another place outside the home. It can be triggered when sleeping.

• Sexual abuse: In case of secondary type of sleep urination, that is, if sleep urination occurs later in children who stay dry at night, sexual abuse should be considered.

• Urinary tract infections: In the presence of infection, it may become difficult to hold urine. Signs of infection such as urination during sleep, urinary incontinence during the day, increased urinary frequency and a feeling of urgency, pink or red urine, and burning sensation during urination may be observed.

• Sleep apnea: Sometimes obstructive sleep may occur. It can also be triggered by problems such as temporary pauses in breathing while sleeping, known as apnea. It may be caused by enlarged tonsils and adenoids. These patients also experience snoring, frequent ear and upper respiratory tract infections, sore throat, or daytime sleepiness.

• Inability to wake up at night: When the bladder is full, it sends signals to the brain, upon these signals. Thanks to the signals going from the brain to the bladder, the bladder relaxes. As bladder filling increases, outgoing signals also increase and the child wakes up. If the child has not learned to respond to these signals, urination during sleep occurs.

• Diabetes: Urination during sleep may be the first sign of diabetes in a child who usually stays dry at night. Increased amount of urine and frequent urination, thirst, fatigue, loss of appetite It is accompanied by weight loss without weight loss.

• Chronic constipation: The muscle groups that control urine and stool are common. In case of long-term constipation, dysfunction in these muscles may occur and urination during sleep may occur.

• Structural disorders of the urinary tract and nervous system: In rare cases, urination during sleep may be associated with urinary tract and nervous system problems.

If no underlying cause can be found, psychological reasons should be investigated.

• Premature and pressured toilet training (the most common why),

• The mother is extremely meticulous and organized

• No toilet training is given.

• Overprotectiveness of the mother.

• Anxiety caused by problems in the family such as death, separation, discord, illness, school failure.

Are there any conditions that increase the risk?

• It is twice as common in boys

• The risk increases if the mother and / or father have a similar history

• It is more common in children with attention deficit and hyperactivity disorder

What kind of problems does it cause?

Other than being an annoying situation, urination during sleep does not cause any health problems if it is not caused by a physical reason. This condition affects children the most. Since it is not accepted as an illness by the parents, the child is blamed and punished. Feelings of guilt and shame negatively affect the child's self-esteem. He/she misses social activity opportunities such as camping or spending the night with a friend.

How is the diagnosis made?

First, a detailed medical history and physical examination should be performed. If the doctor suspects another underlying disease as a result of the examination, additional tests may be performed.

• Urinary analysis: Infection and diabetes are investigated.

• Radiological examination: If structural kidney and bladder problems are suspected, ultrasonography, IVP (intravenous pyelography, etc.) are performed.

• Blood analysis

What is the treatment approach?

A The attitude of parents is very important. In most cases, the child is punished and compared to his/her siblings with feelings of anger and shame. On the contrary, in some families, diapers are reverted to and sleep urination is supported unconsciously with affectionate attitudes while changing the diaper. It should be known that neither punishment nor rewarding with affectionate behavior would be right.

First of all, the child should be supported and it should be known that this is not a situation that occurs knowingly and willingly. Children do not pee in their sleep to disturb their parents. Scolding, shaming, or punishing is not appropriate and will do more harm than good to a problem that may resolve on its own. Sometimes behavioral methods applied unconsciously negatively affect the child's quality of life. Therefore, professional help should be sought.

If no medical cause can be found, behavioral treatments and drug treatments can be used.

Behavioral treatments

• Fluid restriction: Fluid intake is restricted 2 hours before bedtime. Although it is believed that fluid restriction will prevent urination during sleep, it has no benefit, and studies have also been reported showing that restrictions increase tension and make urination during sleep easier.

• Do not give food and drinks containing caffeine

• Gaining the habit of going to the toilet before sleep: Emptying the bladder before sleep may reduce the possibility of urination during sleep.

• Double voiding: Emptying the bladder twice in a row at short intervals, before the bedtime routine and right before going to bed, may be beneficial.

• Gaining the habit of going to the toilet regularly during the day: The habit of holding urine negatively affects bladder emptying and may cause urination problems during sleep.

• Waking up at night: This is the most common time for urination during sleep. After 1.5 hours of sleep, the child should be woken up and the bladder should be emptied. The child must be fully awake.

• Constipation should be treated

• Bladder exercise: When the need to urinate is felt, urination times are extended in short intervals and the bladder is relieved. its capacity gradually

• Enuretic alarm: It is a small, battery-powered device. The wetness sensor part is placed in the child's underwear, in the area where wetness will first occur. As soon as wetting occurs, it wakes up the child with a loud alarm or vibration. After a while, the child gets used to feeling that his bladder is full and starts to wake up on his own and urinate in the toilet. It is the most effective treatment method.

• Providing psychological counseling: It is recommended in case of secondary sleep urination that develops after a traumatic experience or in order to overcome self-confidence problems in the child.

Are there alternative treatment methods?

Hypnosis, acupuncture, chiropractic treatment, diet and herbal treatments are tried for this purpose. There is only limited scientific data on hypnosis and acupuncture and they do not have proven scientific effectiveness. There has been no research to support their use regarding the other methods listed.

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